When are X-Rays or Diagnostic Imaging Necessary

Most patients think or believe that X-rays and or MRI are necessary to treat common musculoskeletal conditions. These diagnostic procedures can tell the doctor a lot about structure but not alway necessary when treated these common conditions.

First we must differentiate between these two commonly used test. X-ray is mainly used in Urgent Care, Primary Care, and Orthopaedic offices. MRI’s are typically utilized in the hospital or at a large radiology practice. X-rays are commonly used to rule out fracture or dislocation after a traumatic event. It only shows osseous structures, like the bones but will also show the disc space and joint space between bones. MRI is more diagnostic but also more expensive, which may require authorization by your health insurance company before the test can be performed. Doctors have to prove medical necessity before the exam can be performed.

Lets look at when x-rays should be considered by your doctor. The first thing they must do is to perform a thorough medical evaluation. This includes all past and present medical history which is given by the patient. The doctor will want to know some key points when deciding what diagnostic images to request. Any sort of major trauma, unexplained weight loss, previous history of cancer, pain that is present for extended period of time, insidious onset are just a few examples of when an X-ray may be indicated.

MRI test are more so to evaluate the soft tissue that can’t be seen on plain film X-ray. MRI’s are great for evaluating swelling, masses, the cause of radicular symptoms, unremarkable X-rays, pain due to overuse conditions, sprain and strain injuries. Of course there are many other indications but for our purpose these are some of the most common reasons for ordering an MRI.

Is it required to have an X-ray before seeing a chiropractor? The answer depends on your history. Do you have any of the red flags like mentioned above. Some of the major ones are a history of cancer, unexplained weight loss, neurological or motor weakness, history or corticosteroid use, trauma, unexplained swelling or masses, suspicion of infections, instability, history of surgery, and failed conservative treatment. The determination of wether diagnostic imaging is necessary is bestowed upon the doctor. They should review all information present and decide with their is clinical indication for advanced imaging.

For the most part, X-rays are over utilized and really don’t tell the doctors about what is causing your musculoskeletal conditions. A lot of times simple orthopedic test will explain why you are having the symptoms and then a proper treatment plan will be developed. Advanced imaging can be expensive for the patient and a lot of time are unremarkable.

Most of our aches and pains come from repetitive movements, poor posture, and unhealthy lifestyle choices. Chiropractors are great a diagnosing musculoskeletal issues as well as mechanical problems that develop over time. If the conservative approach doesn’t help within the first few weeks, it may be time to consider that advance imaging. Dr. Gibson is a chiropractor in Morrisville at RTP Chiropractic and is trained on when to order advanced diagnostic imaging to diagnosis your musculoskeletal conditions.