Patient Referrals for Diagnostic Imaging

Patient referrals for diagnostic imaging and further testing can be difficult of private practice healthcare professionals. Who do you trust with your patients? Who has what equipment/facilities for diagnostics? What are the costs involved? And who pays for this service? Are you a healthcare provider in Newbury or West Berkshire who may find it hard to get quick and easy access to x-rays of other diagnostic imaging modalities? Well this post is designated for other local health care providers/practitioners who may have patients you need to refer for diagnostic imaging but don’t have much information to go on. Keep and eye on our services page for referral forms and keep the other eye on this blog for updates to what diagnostic imaging services we will be providing.

As you may be aware, here at Spriggs Chiropractic, we have on site x-rays a Quantum Medical Imaging machine that we use on our patients for diagnostics. Quantum deliver hospital standard machines to provide the highest image quality. These x-rays can and are used for mainly spinal imaging, however is also used for analysis of extremities, such as:

• Shoulders
• Elbows
• Hands/wrists
• Hips
• Knees
• Pelvis
• Feet
• Ankles

X-rays taken at Spriggs Chiropractic and Nutrition

Spinal X-rays

Spinal x-rays taken at Spriggs Chiropractic are regional, that is the machine has a regional bucky allowing us to get high quality images of the patients cervical, thoracic or lumbar spine regions. However, the machines software allows for easy stitching of the regional images to provide an image of the patients full spine. This is great for patients with increased thoracic kyphosis or patients with scoliosis where the whole spine requires assessment. All projections are obtained with the patient in a weight bearing posture. For more information about why we obtain upright, weight bearing x-rays, please read our blog post on the topic.

What Images can be Requested?

• Regional spinal views (A-P or P-A and lateral views as standard per region)
• Cervical spine flexion and extension in cases of whiplash injury and for assessment of cervical spine instability (e.g. Rheumatoid arthritis)
• Lumbar spine flexion and extension in cases of lumbar instability (e.g. suspected spondylolithesis)
• Lumbar spine lateral flexion left and right
• Fergusson pelvic view for assessment of leg length inequalities and full visualisation of the L5 intervertebral disc.

What is Required?

Fill out the form attached to the “Referrals” Page on our website and send it to us. This needs to be done through a secure email or by post. We use Egress Swift for secure emails or a password protected Drop Box link. We call the patient and book their appointment at their next earliest convenience.

What Happens When you Refer your Patient to us?

During the patients’ appointment, the patient is required to provide information about themselves and their complaint so that patient identification can be verified. Under the new 2018 IR(ME)R guidelines, the patient must be subjected to a physical examination by our Doctors of Chiropractic before the x-rays can be obtained. This is so that the exposure of the patient can be justified by second opinion so errors and unnecessary exposure of patients are avoided. The patient must also provide written consent prior to both physical examination and x-ray exposures can take place. Once these are achieved, the patient is then brought through for the exposures you have requested for this patient. Any additional projections can be either obtained based on the chiropractors experience with your prior consent. These are necessary in patients with a whiplash injury for example, where segmental stability of the cervical spine may be brought into question by the initial exposures. No additional costs are imposed on the patient for additional views obtained during the examination.

At the end of this appointment, the patient is then simply sent back to you for their treatment, its that easy.

Reports

Once the x-rays have been obtained, analysis of the x-rays are then performed at the clinic by experienced clinicians with additional education, including masters degrees in diagnostic imaging. Evaluations for serious pathology is performed first. In cases of spinal imaging only, biomechanical evaluation can also be performed where each segment of the spine is measured using validate and reliable methods of measurement. These include the posterior tangent method^1–7, endplate analysis^8,9, Cobb angles, Risser-Fergusson angles and instantaneous axis of rotation in situations where motion x-rays have been captured^10–15. Biomechanical measurements of the spine are used by spinal surgeons and spinal experts worldwide, chiropractic should therefore be no different. More information into the reliability of these measurements can be found on the CBP Non-Profit website where you can read the published peer reviewed literature on the topic.

Reports are then written for both these evaluations or can be provided as one document if requested. These include physical examination findings, x-ray findings and biomechanical analysis of the spine in cases of severe trauma or when stability of the patients spine has been assessed.

NB if a projection requires additional evaluation for confirmation, the clinic will refer these images to a Chiropractic radiologist (DACBR) or medical radiologist for further evaluation. These will be performed by the clinic without any additional information from you, the referring clinician. In such cases

Who Pays?

The patients are charged at their appointment for the service. A total cost 0f £150 is charged to the patient at the start of their appointment when they fill out their patient information sheet.

Patient referrals for diagnostic imaging might not seem a straight forward process. We want to make referring your patients for diagnostic imaging as easy as possible. Simply fill out the form or give us a call on 01635 432383 and we will talk you through the whole process. We also have access to private lab testing for blood work and stool samples for example and can advise on referral for advanced imaging such as ultrasound, CT and MRI where required. Referrals for advances imaging will be discussed with you and the patient on a case-by-case basis to make sure your patients get the appropriate treatment and best course of action. These recommendations will be provided on your reports. More information regarding functional testing, see our Spriggs Nutrition website.

References:

1. Jackson BL, Harrison DD, Robertson GA, Barker WF. Chiropractic Biophysics lateral cervical film analysis reliability. J Manipulative Physiol Ther. 1993;16(6):384-391.
2. Troyanovich SJ, Harrison DE, Harrison DD, Holland B, Janik TJ. Further analysis of the reliability of the posterior tangent lateral lumbar radiographic mensuration procedure: concurrent validity of computer-aided X-ray digitization. J Manipulative Physiol Ther. 1998;21(7):460-467.
3. Harrison DE, Harrison DD, Cailliet R, Janik TJ, Holland B. Radiographic Analysis of Lumbar Lordosis. Spine (Phila Pa 1976). 2001;26(11):e235-e242. doi:10.1097/00007632-200106010-00003
4. Harrison DE, Harrison DD, Cailliet R, Troyanovich SJ, Janik TJ, Holland B. Cobb method or harrison posterior tangent method: Which to choose for lateral cervical radiographic analysis. Spine (Phila Pa 1976). 2000;25(16):2072-2078. doi:10.1097/00007632-200008150-00011
5. Harrison DE, Holland B, Harrison DD, Janik TJ. Further reliability analysis of the Harrison radiographic line-drawing methods: Crossed ICCs for lateral posterior tangents and modified Risser-Ferguson method on AP views. J Manipulative Physiol Ther. 2002;25(2):93-98. doi:10.1067/mmt.2002.121411
6. Harrison DE, Cailliet R, Harrison DD, Janik TJ, Holland B. Reliability of Centroid, Cobb, and Harrison Posterior Tangent Methods. Spine (Phila Pa 1976). 2001;26(11):e227-e234. doi:10.1097/00007632-200106010-00002
7. Harrison DE, Harrison DD, Cailliet R, Janik TJ, Holland B. Radiographic analysis of lumbar lordosis: centroid, Cobb, TRALL, and Harrison posterior tangent methods. Spine (Phila Pa 1976). 2001;26(11):E235-42.
8. Polly DWJ, Kilkelly FX, McHale KA, Asplund LM, Mulligan M, Chang AS. Measurement of lumbar lordosis. Evaluation of intraobserver, interobserver, and technique variability. Spine (Phila Pa 1976). 1996;21(13):1530-1536.
9. Propst-Proctor SL, Bleck EE. Radiographic determination of lordosis and kyphosis in normal and scoliotic children. J Pediatr Orthop. 1983;3(3):344-346.
10. Aryan HE, Newman CB, Nottmeier EW, Acosta FLJ, Wang VY, Ames CP. Stabilization of the atlantoaxial complex via C-1 lateral mass and C-2 pedicle screw fixation in a multicenter clinical experience in 102 patients: modification of the Harms and Goel techniques. J Neurosurg Spine. 2008;8(3):222-229. doi:10.3171/SPI/2008/8/3/222
11. Wu S-K, Kuo L-C, Lan H-CH, Tsai S-W, Chen C-L, Su F-C. The quantitative measurements of the intervertebral angulation and translation during cervical flexion and extension. Eur spine J Off Publ Eur Spine Soc  Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. 2007;16(9):1435-1444. doi:10.1007/s00586-007-0372-4
12. Frobin W, Leivseth G, Biggemann M, Brinckmann P. Sagittal plane segmental motion of the cervical spine. A new precision measurement protocol and normal motion data of healthy adults. Clin Biomech. 2002;17(1):21. http://search.ebscohost.com/login.aspx?direct=true&db=amed&AN=0034448&site=ehost-live.
13. Penning L. Normal movements of the cervical spine. AJR Am J Roentgenol. 1978;130(2):317-326. doi:10.2214/ajr.130.2.317
14. Dvorak J, Froehlich D, Penning L, Baumgartner H, Panjabi MM. Functional radiographic diagnosis of the cervical spine: flexion/extension. Spine (Phila Pa 1976). 1988;13(7):748-755.
15. Dvorak J, Panjabi MM, Grob D, Novotny JE, Antinnes JA. Clinical validation of functional flexion/extension radiographs of the cervical spine. Spine (Phila Pa 1976). 1993;18(1):120-127.