X-ray Guidelines Skull X-rays. When head trauma results in unconsciousness, and physical findings (like unequal pupils, blood behind the eardrum, depressed bone fragment) suggest serious injury, skull X-rays are certainly appropria_te. In situations where there is no loss of consciousness, where head trauma has been minimal, and no physical findings present themselves, close observation may be substituted for an X-ray. Many emergency-room doctors will recommend X-rays on childrrn in this situation, but responsible monitoring of the child by the family must be considered a r_ealistic option. • Neck X-rays. Indirect trauma to the neck, as in whiplash, often results in taking numerous X-rays in the iegion of the neck. Ironically, these X-rays are often taken at the insistence of the 'patient, rather than the doctor; insurance claims and lawsuits, rather than any medical priority, are the reason. If you want to win your lawsuit, you may need the X0 ray. But if you are primarily concerned about your health, a good physical examination of the neck can often make X-rays unnecessary. Physical diagnosis of ne'ck problems; and corresponding treat7 ment utilizing massage, physiotherapy, and spinal adjustments, are1areas where chiropractic excels. If you can convince your • chiropractor to proceed without X-rays, chiropractic treatments can sometimes offer a radiationless alternative to medical procedure. X-rays of the neck are also commonly taken to diagnose arthritis; again, the salient question is, will the results of the X-ray alter treatment-of the condition, whether or not the condition is officially labeled arthritis. Chest X-rays. We do not believe that chest X-rays should be used ·for routine screening for TB or other chest disorders in asymptomatic individuals. Yet in cases of chest trauma, shortn~ss of breath, c;hest infections accompanied by chills and fever, and situations where the active presence of cancer or TB is expected, they are necessary. Cardiovascular X-rays. This.is one area where routine physical examination offers insufficient data upon which to base a diagnosis. There are a number of heart conditions which can- ' not be treated w_ithout the information provided by an X-ray. Congestive heart failure, valvular lesions, and con.genital heart problems are examples of such conditions. In cases of heart failure, chest X-rays may be necessary to monitor clini~al , progress, and a series is usually taken over a period of time. Arteriograms, in which dye is injected into the arteries and an X-ray taken to determine the condition of the blood ves- • sels, is becoming an increasingly popular proced~re. These should not be done simply for a "look-see_," but limited to_ . cases in which the patient is a bona fide surgical candidate, and where the surgery itself offers a realistic-hope of improvement. In general, because of the serious nature of cardiovascular disease, card-iovascular X-rays are an important part of a successful diagnostic and tre<ltment program. Upper gastrointestinal X-roiys. These are often necessary to confirm the presence of an ulcer, and to distinguish between a gastric and duodenal ulcer, as the two have distinctly different treatments. Also, in the case of gastric ulcers, X-rays are needed to rule out the possibility of cancer. As we have mentioned earlier in this section, your ability to communicate and carry on a meaningful relationship with your doctor is a very important part of receiving good health care. This matter of ~-rays is an excellent case in point. The doctor's needs in this area must be balanced against your own, and this can happen only when the doors of genuine communication are open. Generally ·speaking, a good,doctor February-March 1979 RAIN Page 5 Lower gastrointestinal exams. This procedure involves the use of barium enemas to obtain information about the condition of the rectum and lower intestine. The most valid indication for their use is bleeding from the lower intestinal tract which cannot be identified by sigmoidoscopy. The vast majority of serious rectal conditions are within the reach of the examining finger and the sigmoidoscope. X-rays may also be used in select cases of colitis when it is medically important to determine the extent of involvement. Kidney X-rays. Generally, this is an area where X-rays are used appropriately. Often they are performed when bleeding from the urogenital tract cannot be accounted for by the presence of infec.tion and rouses suspicion of cancer or chronic kidney disease. RecurrerH episo~es of kidney and bladder infections in both adults and children also call for X-ray diagnosis. Rare cases of hypertension may be caused by abnormalities of the kidney which can be disclosed through X-ray. Extremities. X-rays are indicated whenever physical examina- . tio~ points to the possi,bility of a fracture. X-rays of the extremities are probably the least ris¼y, and the degree to which they aid the doctor in the job of setting the bone is considerable. Additional X-rays can be expected and justified when fractures are not healing.properly, or when a functional deformity is present. In cases where _lingering bone muscle or joint pain does not respond to conservative treatment over time, an X-ray would be indicated. Arthrograms (dye injection 'of the joints) may be helpful to the operating surgeon after the decision to operate has been made. Rarely should these findings alone be used to determine the course of treatment. Dental. We cannot recommend routine use of X_-rays for dental check-ups. A-good diet_and proper care of the teeth _ and mouth can make such X-rays unnecessary to begin with. Furthermore, a skillful dentist should be able to look, pick, and diagnose most dental problems without resorting to • X-rays. In certain instances, a spot film of a specific problem area may help guide your dentist's hand. Above all, however, be wary of a fulf mouth series "just to be safe." Chiropractic. This is a difficult area to evaluate, since many chiropractors feel that X-rays are vital to their prac'tice. Some of the most skilled chiropractors make little use of X-rays, trusting instead in their hands and po~ers of observation for diagnosis. The individual consumer of chiropractic care has two op~ionr (1) search out a chiropractor who is willing to work without X-rays, and (2) evaluate the need for X-rays as a part of benefic,ial treatment, focusing on the question of whether the treatment offers sufficient improvement in life and function to warrant the risk. Our general feeling on this matter is that chiropractic would do well to reduce greatly its reliance on X-rays. Retakes. Any o~ the above X-rays may pave to be repeated in order to get the desired results. To err is human, but it's your health that the technician is erring with. If you suspect that you have an inexperienced technician at the controls, demand to see his or her superior to discuss the situation. The X-ray ·room is n~ place for on-the-job t;raining- at least when a human body is on the X-ray table. will use fewer X-rays than a poor one. The more skilled the doctor is in the whole art of diagnosis, including the physical diagnostic skills of looking, touching, and listening, the less he or she will nave to rely on X-rays to "get the picture." When a good doctor meets an activated patient, X-rays can be placed in the proper perspective.
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