Should I get X-Rays?

Should I get X-Rays?

I’d like to clue you in to a piece of who we are and what makes us a little bit different: we don’t take unnecessary x-rays.

We’re going to delve a little bit into x-rays here, and why x-rays can be good or not so good. When we say we don’t shoot unnecessary x-rays, what that means is that not every single patient who walks in the door is going to get an x-ray. There are some chiropractic clinics out there where, if you walk in the door and want to get treatment, step one is that you need to get an x-ray. I’m not saying that that’s a bad thing, but that’s not how we practice here.

Some patients come in and they have neck pain or lower back pain, which is usually a common neck or back pain that we don’t think is related to anything ominous or dangerous, therefore, we don’t need an x-ray to begin treating them. We can start treatment, and if we don’t get great results, we can go back and order imaging after the fact. So, when we say we don’t shoot unnecessary x-rays, that’s what we’re talking about. Not everybody needs x-rays.
Now, we do order x-rays. I order x-rays and MRIs all the time. For patients who aren’t responding to care, or who have certain accidents or injuries that you’re going to need some of this imaging for, we do that imaging pretty routinely. So, the accepted standards for a lot of the need for imaging we still hold, but it’s not accepted in the medical community that every single patient, every single time should get x-rays. That doesn’t make much sense.
So, why would we care? Why does it really matter if every patient is getting an x-ray or not? Well, it used to matter a little bit more, because prior to digital x-rays, there was a lot more radiation involved. You can get a little bit of radiation exposure just from the earth, from cosmic rays coming down from outer space hitting you. Some of them are x-rays, some are radiation, and some are cellularly damaging. You get about 3.65 millisieverts of radiation per year—that’s the standard unit that they use, a millisievert. A normal chest x-ray only adds about 0.1 millisievert to that number, so that’s relatively meaningless—it’s like having an extra day outside, which doesn’t really matter much as far as cellular damage goes. Because that’s not such a big deal, we don’t mind ordering extra x-rays.
However, one of the things that has come up recently, a bit too commonly for my likes, is the overuse of CT scans. Inpatient settings especially—emergency rooms, maybe central-care type clinics or other facilities that have these CT scanners—will do a CT scan as general practice on everything that comes through their doors. A chest CT (the same area aforementioned, but with a CT scanner instead of an x-ray unit) gives you seven millisieverts of radiation. So, if getting an x-ray is like having one extra day’s worth of radiation, a CT scan is like having two extra years’ worth. Two extra years of radiation isn’t something to scoff at—your risk of cancer goes up in a real way when you’re talking about figures like that.
So, when you’re looking at the cancer statistics when it comes to common digital x-rays, not much risk, right? Go forward with it. If somebody says they want to shoot an x-ray, it’s probably better to just do the x-ray because the risk to them is relatively low. However, when a facility is doing these routine CT scans, if you don’t necessarily think that something is broken or terribly wrong, maybe opt to skip it and not go that direction. You could potentially just do an x-ray or no imaging at all if it’s a minor accident. Not saying that you should grapple with your doctor, but take control of your healthcare, and when somebody is ordering a test or procedure that you might not understand the ramifications of, raise your hand and say, “Wait a minute. I don’t know if that’s such a great idea.”
And thus back to the original point about unnecessary x-rays—we don’t do anything unnecessarily here. So, when I’m ordering things and doing different procedures here, I can show you the research on why we’re doing it. I can explain the research that shows how it’s going to help you and lay it out step by step. If I couldn’t do that, then we wouldn’t do it. In rare circumstances where a patient is forcing my hand, they may say, “No, somebody else told me that this will work,” and I’ll say, “There’s literally no research on that—are you sure you want to follow through with this? I don’t want to be responsible if it doesn’t work.” If they say, “Yeah, we’re doing it,” and as long as there’s no real risk for the patient, I’m all game. I’m all about risk.
Anyway, that is all I have for this evening. Quick little jawing about x-rays and unnecessary x-rays. I hope you’re having a wonderful week, I will see you next week for maybe a slightly longer and more vigorous Wednesday Night Wellness Live.

About Dr. Merrill

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Dr. Andrew Merrill is a passionate active clinician and owner of Nightlight Chiropractic Orlando where him and his team treat hundreds of patients each month. With a strong background in exercise science from Stetson University, clinical skills from Palmer College of Chiropractic, and continued postdoctoral training in spinal disc injuries and clinical nutrition, Dr. Merrill is very well versed in the healthcare landscape. With topics ranging from "what to do for common ailments" to "why the medical system is failing you" Dr. Merrill and this blog in particular aim to keep readers up to date on what the research shows and how you can put it into practice NOW to keep yourself healthy for a lifetime.