When a person experiences persistent back pain, they often seek care from a Doctor of Chiropractic (D.C.) who may order an X-ray to examine the spine. While the standard plain film X-ray is primarily used for musculoskeletal assessment, D.C.s are also trained to recognize signs of serious underlying conditions like cancer. This article clarifies the intended scope of chiropractic radiography and explains the D.C.’s role in identifying these findings.
The Primary Role of Chiropractic Radiography
A chiropractor’s training in radiology focuses on the biomechanical and structural assessment of the spine and extremities. The principal reason a Doctor of Chiropractic orders a radiograph is to visualize bony structures, which informs the safety and planning of spinal manipulation. Imaging allows the D.C. to identify structural abnormalities contributing to a patient’s pain or dysfunction.
The X-ray provides a detailed map of the spine, helping to detect misalignments, degenerative changes like osteoarthritis, and assess joint space integrity. It is also used to identify fractures, congenital anomalies, or structural curves like scoliosis. These images help rule out conditions that would contraindicate certain manual adjustment techniques. Ultimately, the goal is to establish an accurate diagnosis for a musculoskeletal condition and create a personalized care plan.
Recognizing Potential Pathologies on Plain Films
While the core purpose of a chiropractic X-ray is biomechanical analysis, chiropractors are extensively trained in pathology recognition to identify findings outside their primary scope of practice. This recognition ability is an inherent part of interpreting any diagnostic image. The D.C. looks for “red flags” or incidental findings that suggest a serious underlying non-musculoskeletal pathology, such as a tumor.
Cancer that affects the bone—either a primary bone tumor or, more commonly, metastatic disease—can present with characteristic changes in bone density and structure on a plain film X-ray. A chiropractor looks for lytic lesions, which appear as areas where bone has been destroyed or “eaten away.” Conversely, blastic lesions indicate abnormal new bone formation and show up as areas of increased density or brightness on the film.
Other suspicious signs include an ill-defined border of a lesion, destruction of the hard outer layer of the bone (cortical destruction), or a malignant periosteal reaction. Standard X-rays are limited in their ability to visualize soft-tissue tumors, and small or early-stage bone tumors may not be visible. The presence of these visual cues only indicates the suspicion of a pathology and necessitates further advanced diagnostic testing.
Professional Duty and Mandatory Referral Protocols
Upon identifying a suspicious or clinically significant finding on a radiograph, the Doctor of Chiropractic has a clear professional and ethical obligation to act immediately. The D.C.’s role shifts from a musculoskeletal health provider to a gatekeeper, recognizing the need for specialized medical attention. This duty is mandatory for the practitioner.
The chiropractor is not responsible for providing a definitive diagnosis of cancer, which requires advanced imaging like CT or MRI, laboratory work, and often a biopsy. Instead, their duty is to inform the patient of the concerning finding and to facilitate a prompt referral to the appropriate medical specialist, such as an oncologist or the patient’s primary care physician. Failure to refer a patient with a suspicious finding is considered a breach of professional standards.