Before projecting what the future could bring to imaging in chiropractic, I reflect back to the excitement I experienced in January 1987 awaiting the publication of the first edition of my textbook, Essentials of Skeletal Radiology.
With more than 100,000 copies sold worldwide, sales far exceeded anyone's expectations. The success of this textbook opened a legitimate publishing world to many other scholarly chiropractic authors, such as Cox, Hyde, Anrig, Evans, Foreman, Croft and Bergmann, to publish their work with Lippincott Williams & Wilkins, as well as other noted medical publishing houses.1
As a chiropractic radiologist and published author, I have often been associated with changes in diagnostic imaging and chiropractic - for example, the use of 100-kHz high-frequency X-ray generators by the profession when many in the X-ray industry didn't believe doctors of chiropractic would pay for and utilize this modality.1 Since this modality reduced patient dose and increased radiographic quality, our profession responded admirably. Additionally, with programmable generators, a functioning technique chart built into the X-ray machine allowed doctors of chiropractic to obtain better-quality radiographs by stabilizing their techniques. All that was necessary was to plug in the patient's measurements and the factors were set automatically by means of a computer chip. This technology increased the quality of radiographic work within the profession.
As I look to the future for imaging, I would like to comment on two areas: digital imaging and magnetic resonance imaging (MRI).
Digital Imaging
With advanced computer technology, filmless imaging has finally reached private practice. Whether it is computed radiography (CR) or digital radiography (DR), the means to obtain images without creating a hard copy on film are possible and affordable. The benefits of this technology are enormous and include the following:2,3
- Eliminating all darkroom chemicals and processing.
- Standardizing the X-ray exposure and virtually eliminating repeat X-rays, through the ability to change contrast and density of the image on the computer.
- Eliminating the need to store films.
- Creating the ability to send images over the Internet to a radiologist for assistance with interpretation.
The financial expenditure for CR or DR is now within reach of today's busy chiropractic practice. Two chiropractic colleges, Palmer College of Chiropractic (Davenport) and Life West College of Chiropractic, are completely digital. I predict that all chiropractic schools will become completely digital within the next five years. All imaging will be done with computer software and placed on a CD. The old darkroom will become a "dinosaur" within the profession. Digital imaging has already reached the dental, podiatry and veterinary professions.1-3
Magnetic Resonance Imaging
There have been many advances made in the area of magnetic resonance imaging. The multiplanar capacity of MRI and the physiological information given to the clinician have far exceeded the benefits of computed tomography (CT). New imaging sequences, along with greater sophistication of the equipment, now position MRI as the main imaging modality to evaluate musculoskeletal complaints. When MRI was initially released for use on humans, it was thought to have an application only for the central nervous system. Very quickly, the imaging community realized there was a tremendous application for all of the joints of the human body - to evaluate tendon tears, cartilage abnormality, contusion or tear within muscles or tendons, bone bruises, hidden disc herniations, etc.1
Weight-Bearing and Kinematic MRI
The weight-bearing or stand-up MRI has been a captivating means for doctors of chiropractic to evaluate the spine, particularly the lumbar spine, in the weight-bearing position.1 Patients are usually scanned seated rather than standing, but can be imaged in the position of pain in both flexion and extension or lateral bending. The many scans performed on the weight-bearing MRI machine that I have read about seem to be of good quality and provide information that would not normally be seen on the recumbent MRI. The applications of this technology need further investigation by the chiropractic clinical research community. At the time of this publication, there is an upright weight-bearing MRI on campus at Life Chiropractic College West. It is anticipated that the college will perform appropriate clinical research and further evaluation of weight-bearing MRI and/or the application of kinematic MRI, particularly in the cervical and lumbar region.1
References
- Yochum TR, Rowe LJ. Essentials of Skeletal Radiology, 3rd ed. Lippincott Williams & Wilkins, 2005.
- Yochum TR. What to look for when going digital. American Chiropractor, November 2007.
- Clum G. Diagnostic technology: an interview. American Chiropractor, November 2007.
Dr. Terry R. Yochum is a second-generation chiropractor and a cum laude graduate of the National College of Chiropractic, where he subsequently completed his radiology residency. He is a diplomate of the American Chiropractic Board of Radiology and served as its vice president and president for seven years (1983-1990). An adjunct Professor of Radiology at the Southern California University of Health Sciences and member of the Department of Radiology at the University of Colorado School of Medicine, Dr. Yochum is the co-author of Essentials of Skeletal Radiology – the required textbook in radiology at all 50 chiropractic colleges and used in more than 100 medical schools around the world.