Imaging Standards of Care

Review written by: James Demetrious, DC, DABCO

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Important Resources

The decision to order imaging studies for our patients requires careful assessment with awareness of standards of care and appropriateness criteria. Different conditions and variance thereof can sometimes make the decision to perform x-ray, MRI, or CT quite difficult. When should a study be performed? Should the patient be administered contrast or not? What is most appropriate based on the literature and our clinical experience.

Over the years, practice guidelines have been developed in chiropractic and medicine that offer practitioners insight. Such guidelines are developed from exhaustive systematic reviews by leading researchers in their respective fields.

The Bussières Diagnostic Imaging Practice Guidelines

In 2007, Bussières et al. published chiropractic practice guidelines following a comprehensive search for the appropriate use of diagnostic imaging for spinal disorders. The authors clearly state, The guidelines are intended to be used in conjunction with sound clinical judgment and experience and should be updated regularly. Future research is needed to validate their content.”

The Bussières guidelines are helpful to assist chiropractors and other primary care physicians in the decision-making for the appropriate use of diagnostic imaging. To my knowledge, no updates have been made to these guidelines since 2007.

The American College of Radiology Appropriateness Criteria

Another vital resource available to chiropractors and practitioners includes the ACR Appropriateness Criteria. These are evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition.

The ACR publishes and regularly updates exhaustive reviews and recommendations for the imaging of conditions and their variants. It is important to relate a statement of guideline utilization by the ACR, “The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination.”

Application in Practice

On a daily basis, physicians must make the most appropriate recommendations for their patients. To avoid excessive testing, unnecessary procedures and refine our diagnosis, it is wise to consider the appropriateness criteria for diagnostic imaging utilizing available guidelines combined with the clinical assessment of respective caregivers.

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