Public health

Spinal x-ray clamp down for chiropractors

Chiropractors have lost the right to order whole spine X-rays under changes to the Medicare Benefits Schedule, after a review uncovered overuse.

The removal of requesting rights for 3 and 4 region back X-rays, slated to commence on November 1 subject to approval by parliament, will not apply to physiotherapists, osteopaths and medical practitioners.

The move was recommended by a diagnostic imaging committee, after it was found that chiropractors had ordered most of the approximately 130,000 three region X-rays claimed on the MBS in 2014–15, the department of health said in a fact sheet published online.

“In light of its findings that there has been a high volume of unnecessary testing, and considering the associated radiation risks, the committee proposed that requesting three and four region radiography of the spine be restricted.”

The committee said this type of imaging has a limited clinical role largely confined to medical specialist assessment and management of scoliosis.

“Most presentations of low back pain do not require diagnostic imaging as the result of any imaging is unlikely to change clinical management.”

The committee considered region two spinal X-rays to have clinical value in circumstances where the suspected pathology is at, or close to, the junction of two areas of the spine.

Under the changes, chiropractors will retain ordering rights for region one and two spine X-rays, while all allied health professionals will be capped at ordering a maximum of one region one and one region two spine X-ray for the same patient on the same day.

The move has been welcomed by ARA president Professor Rachelle Buchbinder, who helped shape the recommendations during her time on the low back pain imaging working group which formed in 2014 to assist the MBS Review.

“Inappropriate imaging has the potential to lead to harm including not only the unnecessary radiation, but also labelling someone with disease and downstream effects such as unnecessary further imaging and inappropriate treatments that may result in more harm than benefit,” said Professor Buchbinder, who is also the director of Clinical Epidemiology at Cabrini Institute and Monash University.

“Degenerative changes in the spine are common and increase with age and studies have found that these changes are just as common in people without symptoms.

“Therefore it is usually not possible to determine the specific cause of the pain in most people and imaging has the potential to falsely attribute the pain to what can be seen on the image.”

Given that whole spine imaging does not seem to have an indication for most people with low back pain, most of these imaging tests are likely to be unnecessary, she said.

The move was also positive because it would signal to chiropractors that the imaging approach to back pain is inappropriate, she added.

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