On "phantom risks" associated with diagnostic ionizing radiation: evidence in support of revising radiography standards and regulations in chiropractic.

Radiography has been part of chiropractic diagnostics since shortly after its discovery in 1895, the same year D.D. Palmer discovered chiropractic. In fact, it was B.J. Palmer who brought x-ray to chiropractic in 1910.1 This is what led to a very interesting and rich chiropractic history of technique innovators with their varied radiographic biomechanical analysis systems. Many different x-ray analysis systems are used today in clinical practice and research as well as taught in the chiropractic colleges around the world. In fact, use of radiography for structural data is an integral component to the practice of chiropractic.2,3 With the recent concerns about the profession’s future (i.e. to remain a separate entity or be incorporated into mainstream medicine),4 there has been pressure to restrict the use of radiography in clinical practice.5–10 In fact, recent proposed guidelines suggest that except for ruling out “red flags” (i.e. serious medical conditions such as cancer, infection etc...) no radiographic imaging should be taken for treatment management of patients presenting with uncomplicated low back pain.11–15 To no surprise, the current practice trend is much higher than this.15–18 This commentary is written to present to the profession, and specifically to the advocates of continued restrictive use of radiography in clinical practice and research (i.e. DACBRs), that at low doses of ionizing radiation there is a significant lack of scientific evidence for health risks presumably associated with routine use of radiography. Risks in the diagnostic range cannot be measured very reliably. Just as important, we review some of the data from investigators that supports the notion that there is not only essentially no risk, but perhaps health benefits to such practices.