College of Chiropractic Radiologists Canada, Inc.
Collège des Radiologues Chiropratiques Canada Inc.
STATEMENT OF POLICIES AND POSITION STATEMENTS
CCR Policies and Position Statements are developed by our members and are intended solely for the use of our members.
OUR POLICIES ARE ALWAYS UNDER REVIEW AND MAY CHANGE AT ANY TIME. PLEASE CHECK BACK WITH US AT A LATER DATE FOR THE MOST UPDATED INFORMATION.
SYNOPSIS OF POLICIES AND PATIENT SAFEGUARDS OF THE CHIROPRACTIC COLLEGE OF RADIOLOGISTS (CANADA) INC.
The chiropractic profession recognizes that x-ray examinations, while offering inestimable diagnostic benefits, have risks and possible detriments which must be weighed against those benefits. The C.C.R. affirms that there should always be clinical evidence of need for diagnostic x-ray examinations before such are performed. Use of x-ray as a routine procedure and/or from patient’s self-referral is not good practice and is not condoned.
Proper radiological measures for patient protection including adequate collimation, filtration, gonadal shielding (when applicable) etc. should always be utilized. C.C.R. admonishes doctors of chiropractic to use all known radiation health and safety measures including proper selection of patients with due reference to age, childbearing status and other factors, including clinical indication of need.
Continuing education programs in radiological health and safety are and have been offered through the chiropractic colleges, provincial and national chiropractic associations, and governmental agencies. The chiropractic profession has been among the leaders in the healing arts in participation in such courses and all chiropractors are urged to avail themselves of these. (Approved 1978, Reaffirmed 1989.)
OUR POLICIES ARE ALWAYS UNDER REVIEW AND MAY CHANGE AT ANY TIME. PLEASE CHECK BACK WITH US AT A LATER DATE FOR THE MOST UPDATED INFORMATION.
SYNOPSIS OF POLICIES AND PATIENT SAFEGUARDS OF THE CHIROPRACTIC COLLEGE OF RADIOLOGISTS (CANADA) INC.
The chiropractic profession recognizes that x-ray examinations, while offering inestimable diagnostic benefits, have risks and possible detriments which must be weighed against those benefits. The C.C.R. affirms that there should always be clinical evidence of need for diagnostic x-ray examinations before such are performed. Use of x-ray as a routine procedure and/or from patient’s self-referral is not good practice and is not condoned.
Proper radiological measures for patient protection including adequate collimation, filtration, gonadal shielding (when applicable) etc. should always be utilized. C.C.R. admonishes doctors of chiropractic to use all known radiation health and safety measures including proper selection of patients with due reference to age, childbearing status and other factors, including clinical indication of need.
Continuing education programs in radiological health and safety are and have been offered through the chiropractic colleges, provincial and national chiropractic associations, and governmental agencies. The chiropractic profession has been among the leaders in the healing arts in participation in such courses and all chiropractors are urged to avail themselves of these. (Approved 1978, Reaffirmed 1989.)
Radiology
Periodically, questions concerning the use of diagnostic x-ray by chiropractors are encountered. The Chiropractic College of Radiologists (Canada) Inc. has developed certain basic policies and positions regarding these definitive questions.
Following are the adopted policy statements and guidelines approved and published by The Chiropractic College of Radiologists (Canada) Inc. in 1978 and revised in 1979 and 1989.
Statement on Diagnostic Radiology Procedures by The Chiropractic College of Radiologists (Canada) Inc.
I. Purpose:
To state the College’s position concerning the utilization of diagnostic radiology by chiropractic clinicians and radiologists.
II. Whereas:
A. Chiropractors are duly licensed primary health care providers in their respective jurisdictions;
B. Radiological examinations are necessary and pertinent as accepted procedures for the clinical evaluation of their patients;
C. The chiropractor’s ability to diagnose exceeds his authority to treat; therefore, proper diagnosis results in the appropriate referral when needed.
III. Therefore:
This College states its position that diagnostic radiologic procedures as taught in the chiropractic colleges and approved by the Commission on Accreditation of the Council on Chiropractic Education and within the legal statutes must be a part of the general chiropractic practitioner’s and qualified chiropractic radiologist’s diagnostic regime.
Following are the adopted policy statements and guidelines approved and published by The Chiropractic College of Radiologists (Canada) Inc. in 1978 and revised in 1979 and 1989.
Statement on Diagnostic Radiology Procedures by The Chiropractic College of Radiologists (Canada) Inc.
I. Purpose:
To state the College’s position concerning the utilization of diagnostic radiology by chiropractic clinicians and radiologists.
II. Whereas:
A. Chiropractors are duly licensed primary health care providers in their respective jurisdictions;
B. Radiological examinations are necessary and pertinent as accepted procedures for the clinical evaluation of their patients;
C. The chiropractor’s ability to diagnose exceeds his authority to treat; therefore, proper diagnosis results in the appropriate referral when needed.
III. Therefore:
This College states its position that diagnostic radiologic procedures as taught in the chiropractic colleges and approved by the Commission on Accreditation of the Council on Chiropractic Education and within the legal statutes must be a part of the general chiropractic practitioner’s and qualified chiropractic radiologist’s diagnostic regime.
X-Ray Record Keeping
A record, sufficiently detailed for audit, shall be maintained on each patient and, in addition to information identifying the patient, must contain:
a. a recent history including record of last menstrual period in the case of a female who is pregnant or of child-bearing age;
b. results of chiropractic, neurologic or orthopaedic examination performed by a chiropractor;
c. clinical indicators for diagnosis;
d. the specific reason for which the radiodiagnostic examination is being conducted, e.g. differential diagnosis, treatment planning indicators, etc., the results of the reading of the radiograph, the subsequent action recommended and/or taken as a consequence of the examination;
e. date of examination;
f. part of body x-rayed; and
g. technical factors used.
STATUTE OF LIMITATIONS
The Income Tax regulations governing record keeping are applicable to those portions of the records pertaining to income.
Because currently the actions for malpractice (torts) are under the common law and required to be commenced within six years from the commencement of the cause of action, a chiropractor shall keep the records required (including x-rays) in a systematic manner and shall retain each record for a period of six years after the date of the last entry in the record or until the member ceases to engage in the practice of chiropractic, whichever occurs first.
a. a recent history including record of last menstrual period in the case of a female who is pregnant or of child-bearing age;
b. results of chiropractic, neurologic or orthopaedic examination performed by a chiropractor;
c. clinical indicators for diagnosis;
d. the specific reason for which the radiodiagnostic examination is being conducted, e.g. differential diagnosis, treatment planning indicators, etc., the results of the reading of the radiograph, the subsequent action recommended and/or taken as a consequence of the examination;
e. date of examination;
f. part of body x-rayed; and
g. technical factors used.
STATUTE OF LIMITATIONS
The Income Tax regulations governing record keeping are applicable to those portions of the records pertaining to income.
Because currently the actions for malpractice (torts) are under the common law and required to be commenced within six years from the commencement of the cause of action, a chiropractor shall keep the records required (including x-rays) in a systematic manner and shall retain each record for a period of six years after the date of the last entry in the record or until the member ceases to engage in the practice of chiropractic, whichever occurs first.
Position Statement Regarding The Number Of Radiographs Per Radiological Evaluation
1. Everything we do must be based upon a clinical indication and judgement for the necessity of our procedures and practices, including x-ray examinations.
2. A proper history and clinical evaluation on each specific case must be made as an indicator for the necessity of a radiographic examination.
3. The history and clinical evaluation is a guide as to which portion of the body should be x-rayed and an indication as to how many different views should be taken.
4. In using radiograms as a diagnostic aid, all necessary views should be taken to help consummate a diagnosis. Unnecessary projections or unnecessary body parts should never be taken.
5. It is absolutely necessary to take at least two views of an affected osseous area, preferably at right angles to each other in order to have minimum radiological impression. Frequently, it is advisable to make multiple projections when there is an indication of possible fracture, significant pathology, congenital defect or when an initial study is insufficient to make a comprehensive diagnosis.
6. Repeat, or serial examinations should be done only to help confirm clinical suspicions of changes which need to be known for the benefit of the patient. If the patient makes an adequate clinical recovery, serial x-rays would not normally be indicated (exceptions would be to check progress of fracture repair, infectious processes, scoliosis and disability evaluation). If the patient does not make an adequate response, then serial x-rays may be indicated based upon clinical re-evaluation of the patient.
7. A patient should never be exposed to unnecessary radiation. Areas of exposure as well as the number of exposures should be kept to a minimum.
NUMBER OF RADIOGRAPHS PER RADIOLOGICAL EVALUATIONSUMMARY
The number of views taken and when they are taken is always a judgement factor based upon the clinical indications, and a rule for this can never be categorically stated. The minimum number of views to reach a diagnostic conclusion should be the prime objective. Two views, preferably at right angles, are the minimum number of projections for osseous structure diagnosis.
2. A proper history and clinical evaluation on each specific case must be made as an indicator for the necessity of a radiographic examination.
3. The history and clinical evaluation is a guide as to which portion of the body should be x-rayed and an indication as to how many different views should be taken.
4. In using radiograms as a diagnostic aid, all necessary views should be taken to help consummate a diagnosis. Unnecessary projections or unnecessary body parts should never be taken.
5. It is absolutely necessary to take at least two views of an affected osseous area, preferably at right angles to each other in order to have minimum radiological impression. Frequently, it is advisable to make multiple projections when there is an indication of possible fracture, significant pathology, congenital defect or when an initial study is insufficient to make a comprehensive diagnosis.
6. Repeat, or serial examinations should be done only to help confirm clinical suspicions of changes which need to be known for the benefit of the patient. If the patient makes an adequate clinical recovery, serial x-rays would not normally be indicated (exceptions would be to check progress of fracture repair, infectious processes, scoliosis and disability evaluation). If the patient does not make an adequate response, then serial x-rays may be indicated based upon clinical re-evaluation of the patient.
7. A patient should never be exposed to unnecessary radiation. Areas of exposure as well as the number of exposures should be kept to a minimum.
NUMBER OF RADIOGRAPHS PER RADIOLOGICAL EVALUATIONSUMMARY
The number of views taken and when they are taken is always a judgement factor based upon the clinical indications, and a rule for this can never be categorically stated. The minimum number of views to reach a diagnostic conclusion should be the prime objective. Two views, preferably at right angles, are the minimum number of projections for osseous structure diagnosis.
Lateral Bending Views of the Spine
A. Are reserved additional views, not considered as part of the initial routine radiographic examination; unless specific trauma or biomechanical dysfunction is documented by history or clinical evaluation which suggest findings unobtainable by other means.
B. Are performed initially only in those patients where prior treatment has been unsuccessful or where objective clinical findings or treatment resistive symptoms suggest an as yet undiscovered occult pathology.
C. Are performed only of the cervical or lumbar spine.
D. Are to be performed sectionally, unless used to demonstrate fixation of scoliosis.
E. Repeat utilization is rarely indicated except in those cases where appropriate response to treatment is lacking or where re-injury or exacerbation has been clinically documented.
B. Are performed initially only in those patients where prior treatment has been unsuccessful or where objective clinical findings or treatment resistive symptoms suggest an as yet undiscovered occult pathology.
C. Are performed only of the cervical or lumbar spine.
D. Are to be performed sectionally, unless used to demonstrate fixation of scoliosis.
E. Repeat utilization is rarely indicated except in those cases where appropriate response to treatment is lacking or where re-injury or exacerbation has been clinically documented.
Free Examinations |
The C.C.R. strongly condemns as unethical and dangerous the practice of advertising free spinal x-ray examinations and other indiscriminate uses of x-ray as part of practice building schemes and/or other equally unethical purposes. (Approved 1978, reaffirmed 1989.)
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Definition: Investigational |
As defined by Clinical Guidelines for the Practice of Chiropractic in Canada
“Evidence is insufficient to determine appropriateness. Further study is warranted. Use for a given indication in a specified patient population should be confined to research protocols. As more experience and evidence accumulates, this rating will change. |
C.C.R. Policy on Computer Analysis of X-rays
Currently under review
Canadian Chiropractic Association Policy Statement on the Use and Practice of Radiology in the Chiropractic Profession
WHEREAS diagnostic imaging, specifically radiology, has been an essential diagnostic modality used in chiropractic practice for many years;
WHEREAS radiographic technique and diagnosis are compulsory courses taught in all chiropractic colleges worldwide;
WHEREAS virtually all jurisdictions licensing chiropractors require proof of proficiency in diagnostic radiology by examination;
WHEREAS the Chiropractic Council on Roentgenology, the Chiropractic College of Radiologists and a Council on Chiropractic Education (Canada) accredited specialty in chiropractic radiology has been in existence for many years;
WHEREAS all professions practising the safe and effective use of manipulation/adjustment of the joints, particularly of the spine, generally agree that radiographic evaluation is an important component of the clinical examination that should be performed before its application;
WHEREAS diagnostic radiology is an accepted method of patient examination by primary health care providers and its coverage is available through public and private health insurance plans;
WHEREAS radiological documentary evidence is sought as part of the statements of claim or defense in the litigation process of personal injuries;
BE IT RESOLVED that the Canadian Chiropractic Association affirms the importance of diagnostic radiology in the practice of chiropractic.
Adopted from The C.C.R. “Position Paper on the Use and Practice of Radiology in the Chiropractic Profession”, June 1984
Adopted by C.C.A. Board of Governors, November 3, 1989
WHEREAS radiographic technique and diagnosis are compulsory courses taught in all chiropractic colleges worldwide;
WHEREAS virtually all jurisdictions licensing chiropractors require proof of proficiency in diagnostic radiology by examination;
WHEREAS the Chiropractic Council on Roentgenology, the Chiropractic College of Radiologists and a Council on Chiropractic Education (Canada) accredited specialty in chiropractic radiology has been in existence for many years;
WHEREAS all professions practising the safe and effective use of manipulation/adjustment of the joints, particularly of the spine, generally agree that radiographic evaluation is an important component of the clinical examination that should be performed before its application;
WHEREAS diagnostic radiology is an accepted method of patient examination by primary health care providers and its coverage is available through public and private health insurance plans;
WHEREAS radiological documentary evidence is sought as part of the statements of claim or defense in the litigation process of personal injuries;
BE IT RESOLVED that the Canadian Chiropractic Association affirms the importance of diagnostic radiology in the practice of chiropractic.
Adopted from The C.C.R. “Position Paper on the Use and Practice of Radiology in the Chiropractic Profession”, June 1984
Adopted by C.C.A. Board of Governors, November 3, 1989