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To X-ray or not to X-ray


How many chiropractors have you been to in your life? One? More than one? (If your answer is zero, think about other physicians you’ve visited, such as a medical doctor or a dentist.) Perhaps you found the perfect chiropractor for you and had no desire to go anywhere else, or maybe you’re still looking for the right one. Whichever the case, I want you to do something for me. I want you to think…hard…about what your thoughts were going into a chiropractic office for the very first time. Did you know what you were getting yourself into? Did you have NO idea what to expect so everything was a pleasant surprise? Chances are if you’ve visited multiple chiropractic offices you noticed that no 2 clinics are the same. Why is that?

One of the neat things about chiropractic is the countless ways a physician can choose to practice and the many options available when it comes to designing their office procedures. After deciding where and how to practice, the doc must then decide what is the best method to perform an examination, and the BIG question here is whether to take X-rays.
Since we have an X-ray machine in our office, a question I receive from patients often is, “How come the other doctor didn’t X-ray me?” While I cannot attest to the practices of a fellow chiropractor, I CAN talk about why WE take X-rays in our office.

“Let me guess…you have an article?”

GREAT NEWS! I have an article! Take a gander at this article from ‘Dose-Response: An International Journal” titled, “X-ray imaging is essential for contemporary chiropractic and manual therapy spinal rehabilitation: Radiography increases benefits and reduces risks.” There are many things to take into consideration when deciding whether to incorporate X-rays in an office, but ONE of those things to consider is the risks vs. the benefits.

The main concern here is the potential risk of radiation exposure. We all know that over-exposure to radiation is bad. Take sunlight for example. Too much time in the sun for a day can cause a sunburn. And too much sunlight exposure over years and years could have more serious effects, like skin cancer. But what about X-rays? X-rays are of a higher frequency, so they are more intense when compared to UV rays from sunlight, so the key thing to consider here is the type and duration of radiation exposure.

The risks of taking X-rays.

How many times have you been X-rayed in your life? And how long does it take to get a single X-ray image? If you’re like me, you can count the number of times you’ve been X-rayed on one hand, and in MOST cases it only takes a split second to get a clear X-ray image (this is directly correlated to the size of the body part being X-rayed: i.e. a hand vs. an abdomen).

So, what happens in the body when an X-ray is taken? Since the body is mostly made of water (about 60% water last time I checked), radiation increases the production of reactive oxygen species (ROS) from this water, and these ROS can then damage cellular DNA. The damage that’s done to DNA is where the problem lies. However, the quantity of ROS produced by X-rays is very minor compared to the amount produced by aerobic metabolism, otherwise known as breathing air!

“Wait, what? Breathing air can damage our DNA? That’s crazy! We need air to live!”

I know, right? But fear not! For our bodies have a defense already installed to get rid of these reactive oxygen species BEFORE they cause a problem. This built-in defense is called the immune system! Since breathing is a necessity, aerobic metabolism is constantly running resulting in the production of ROS in the body. By the time an X-ray is taken the immune system is already hard at work to effectively clear these out before they cause damage. The slight increase of ROS from an X-ray is a mere 'blip' on the immune system's radar.

Also, the radiation dose from an X-ray taken at a chiropractic office is about 100 times lower than the threshold dose for harmful effects. In other words, you’re exposed to more radiation walking through an airport than you are at your chiropractor’s office.

Why we take X-rays.

Chiropractic adjustments realign the structure of the spine and address a wide range of pain, muscle weakness, and functional impairments. Chiropractors have very sensitive hands and can depict many misalignments of the spine, but these methods are subjective and are often complicated by body composition and clothing of the patient. Opting for taking X-rays **when indicated** provides an objective view of what the bones and joints are doing under the skin. X-rays are also beneficial for identifying abnormalities that would otherwise have not been found.

High risk abnormalities on X-ray include:
  • Fractures
  • Infections 
  • Inflammatory disorders 
  • Ligament instabilities 
  • Malignancies
Some less serious, but “good-to-know” abnormalities on X-ray include:
  • Abnormal number of bones
  • Fusions (congenital or surgical)
  • Arthritic changes
  • Spinal pathologies

We strive to offer our patients the best quality of care possible, and one of the ways we do this is by offering Motion Analysis X-rays in our office. A typical X-ray series can show what the spine looks like when standing still, but I’m willing to bet you don’t spend most of your day standing still. You move around; bend, lift, twist…the spine is designed to move, and we want to know what the spine is doing in MOTION. Static images are not an accurate representation of how well the spine in functioning, but with Motion Analysis X-rays not only are we able to SEE what the spine looks like, we are able to determine exactly how the spine in functioning. This allows us to put together the most effective and efficient treatment plan customized to each individual patient so we can treat our patients accordingly while keeping in mind the importance of an optimal and timely outcome.

Now, why do we choose to take X-rays when there are potential risks involved? Think about it this way… When you leave your house to drive to the grocery store, you’re taking a risk every time you get in your car. Most car accidents happen less than 5 miles from home, so why risk leaving the house to go to the store? The answer is easy, you need food to feed yourself and your family. Yes, there are risks when getting behind the wheel, but you do it anyway because the benefit of feeding your family outweighs the risks of driving a car. The same can be said for taking X-rays. The benefits of taking X-rays far outweigh the risks, and that is why we do it.

Have more questions about our X-rays? Give us a call!

Until next time!


Oakley, P. A., Cuttler, J. M., & Harrison, D. E. (2018, June 19). X-Ray Imaging is Essential for Contemporary Chiropractic and Manual Therapy Spinal Rehabilitation: Radiography Increases Benefits and Reduces Risks. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29977177

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