Advanced Imaging. Part 1.

February 2023 blog.

Image: International Journal of Spine Surgery

Chiropractors are now able to prescribe advanced medical imaging tests in addition to conventional x-rays for their patients. They can request magnetic resonance imaging tests, scans, ultrasounds or a bone density test, according to the needs of the patient.

In order to provide these new professional services, chiropractors must demonstrate that they have acquired the necessary skills and knowledge and have completed the necessary additional training. This significant advance was made possible through the collaboration of the Collège des médecins du Québec, the Ordre des technologues en imagerie médicale, radio-oncologie et électrophysiologie médicale du Québec and the Ordre des podiatres du Québec. These new activities will give the people of Québec access to an accurate diagnosis and appropriate care in the shortest possible time, while contributing to the increased efficiency of the public health system. In this first part of our blog, we introduce you to each of the new imaging procedures that your chiropractor can prescribe in addition to conventional x-rays.

Tomodensitometry

Commonly referred to as a “scan” or “CT scan”, it is also known as a CAT scan and Computerized axial tomography. The CT scan is very sensitive when it comes to detecting diseases and abnormalities of soft tissue, bone and other anatomical structures. Images are acquired very quickly using this technique. One disadvantage is that the patient is exposed to moderate to high doses of radiation.

Bone Density Scan

Bone densitometry is used to measure bone density. It can be used to check for osteoporosis (a decrease in bone density that makes the bones more fragile). It is worth noting that a standard x-ray is not useful for diagnosing osteoporosis. The radiation emitted during such an examination is very low for the patient.

Diagnostic Ultrasound or Ultrasound

As suggested by its name, this technique uses sound waves to create an image. In addition to being used extensively in obstetrics, ultrasound is useful for evaluating soft tissues such as tendons, muscles and ligaments. A good example of when diagnostic ultrasound is used is to visualize shoulder tendons such as the rotator cuff. The cost of this technology is relatively low and the patient is not exposed to radiation. The structures to be visualized must, however, be superficial (just below the skin).

Magnetic Resonance Imaging (MRI)

MRI allows for a very detailed evaluation of the “soft” parts, i.e.,joints, bone marrow and nerve structures (nerves, spinal cord, etc.). It is frequently used to diagnose spinal nerve compressions, such as those resulting in herniated discs. The patient is not exposed to any harmful radiation with the MRI.However, it is very expensive and obtaining the images takes a long time. There are also several contraindications to this examination (pacemaker, subcutaneous insulin pump, pregnancy, orthopedic prostheses, etc.).

These are the 4 types of advanced imaging that chiropractors can now prescribe in addition to X-rays. Chiropractors may do so when it is within the scope of their practice, within their skills and knowledge and of course when required by the patient’s condition.

In Part 2 of this blog, we will discuss specific situations in which your chiropractor may prescribe advanced imaging.