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Do Upper Cervical Chiropractors Take X-Rays?

The use of x-rays in chiropractic care is a topic of debate. While spinal x-rays are often considered standard for initial evaluations, many musculoskeletal issues that chiropractors treat are mechanical and do not show up on x-rays. These issues can often be resolved with manipulation or mobilization treatments. It may be more reasonable to first try chiropractic care and only consider x-rays if symptoms persist.

For more complex conditions, initial x-ray analysis may be required.

Dr. Brett reviewing thermographic spinal analysis

X-rays as diagnostic tools

Similar to other healthcare providers, chiropractors have a specific approach that they follow to treat their patients. When you visit a chiropractic clinic for an evaluation, the practitioners will typically follow a specific workflow that includes:

  • Subjective observations

  • Objective observations

  • Assessment

  • Planning of treatment

The subjective observation will consist mostly of interview questions; it starts with your complaint plus the reasons that prompted you to seek chiropractic care. The objective observations are part of the physical exam, and the chiropractor may request x-ray imaging as part of this process. Healthcare practitioners cannot advance to the next step, the assessment, until they are satisfied that the sum of the subjective and objective observations can add up to a solid diagnosis.

Are x-rays safe in chiropractic offices?

According to chiropractic professionals, there are no negative effects of diagnostic X-rays in their offices. The estimated radiation exposure to a patient during plain X-ray examinations of the spine is 0.2, 1.0, and 1.5 mSv for the cervical, thoracic, and lumbar regions, respectively [1]. Studies have not shown evidence of a carcinogenic effect for acute irradiation at doses less than 100 mSv or for protracted irradiation at doses less than 500 mSv [2]. The American College of Radiology also states that adverse health outcomes for radiation doses below 100 mSv are not supported by evidence [3]. In chiropractic practice, it would require a significant amount of x-rays in a single encounter or over a protracted time to cause any adverse effects. However, neither of these circumstances occur in chiropractic practices as the safe use of radiation is emphasized in chiropractors’ doctoral training and only necessary X-rays are taken.

How do upper cervical chiropractors interpret x-ray images?

Although chiropractors approach patient care holistically, they tend to focus on musculoskeletal conditions that are amenable to x-ray imaging. For example, if a patient is experiencing persistent lower back pain, the chiropractic exam may suggest that a misalignment of the vertebrae is causing nerve strain, but it is important to rule out any other potential conditions before spinal manipulation is attempted. If x-rays reveal the presence of growths on the vertebrae that were previously unknown, this could pose a risk in terms of manipulation.

In addition to growths, there may be other issues, such as fractures, that could impact the efficacy of chiropractic treatments. When evaluating x-ray images, upper cervical chiropractors are primarily interested in the skeletal structure and whether it can be safely manipulated to provide pain relief and improve overall health and quality of life for the patient.

Are x-rays necessary?

Since every patient and condition is unique, not all cases require x-rays for chiropractic diagnosis or treatment planning. Chiropractors typically request different types of x-ray images than other healthcare providers. Whenever possible, chiropractors prefer to view images taken when patients are standing up to assess how their posture and weight may be contributing to skeletal displacement. This approach helps chiropractors gain a better understanding of the patient’s condition and formulate an appropriate treatment plan.

Patients who have a history of cancer may be recommended to undergo x-ray imaging by chiropractors to rule out the presence of growths on the vertebrae. Similarly, if a patient has a history of scoliosis or other abnormal curvatures of the spine, closer examination of the spine may require x-rays.

X-rays may need to be taken more than once

Upper cervical chiropractors may request x-rays after the initial consultation if the treatment plan requires spinal manipulation. While improvement may be noticeable, some cases require a more precise assessment of progress made. Chiropractors who have x-ray equipment in their clinics can obtain images of the spine and joints from various angles, making it easier to assess progress. If patients experience different types of discomfort during or after adjustment sessions, this may indicate the development of secondary issues. In such cases, chiropractors may need to take x-rays to determine the next course of action.

How x-rays work

X-rays are a type of electromagnetic radiation that can pass through soft tissues and are directed towards the body to view internal structures. They are similar to wireless communication waves, but are used to create images of internal anatomy. When x-rays pass through soft tissue, they are able to penetrate it, but when they reflect off surfaces such as bones and teeth, they appear white on radiography film or digital imaging. The images display nerves, ligaments, connective tissue, and muscle as shades of gray.

What a patient should expect from chiropractic x-ray examinations

It is important to note that while x-rays are non-invasive, they do expose patients to a small amount of radiation. Chiropractors are trained to use the lowest amount of radiation necessary to obtain the information they need for diagnosis and treatment. They will also take necessary precautions to protect patients from unnecessary exposure, such as using lead aprons or shields to cover sensitive areas. It is important to inform your chiropractor if you are pregnant or suspect you may be, as x-rays may not be recommended in certain cases.

Digital radiography uses a digital sensor instead of traditional film to capture the x-ray images. This means that the x-ray machine emits less radiation, and the images can be processed immediately without the need for chemical development. Additionally, digital images can be manipulated and enhanced for better diagnosis, and they can be easily stored and transmitted electronically. As a result, digital radiography has become the standard of care in many medical and dental practices, including chiropractic clinics.

Digital radiography has many advantages over traditional film-based x-rays. The cost of digital x-rays is often lower than film-based x-rays because digital images can be easily stored and transferred electronically, without the need for expensive processing chemicals and equipment. The images can also be enhanced and manipulated to provide greater detail and clarity, which can aid in diagnosis and treatment planning. Additionally, digital images can be shared instantly with other healthcare providers if necessary, allowing for more coordinated and efficient care.

Foundation Chiropractic utilizes Upper Cervical Chiropractic care to fix the primary cause of various secondary conditions (symptoms). You can call our office at 813–578–5889 to schedule a complimentary consultation.

Disclaimer: Dr. Berner does not diagnose, treat, or prevent any medical diseases or conditions; instead, he analyzes and corrects the structure of his patients with Foundational Correction to improve their overall quality of life. He works with their physicians, who regulate their medications. This blog post is not designed to provide medical advice, professional diagnosis, opinion, treatment, or services to you or any other individual. The information provided in this post or through linkages to other sites is not a substitute for medical or professional care. You should not use the information in place of a visit, consultation, or the advice of your physician or another healthcare provider. Foundation Chiropractic and Dr. Brett Berner are not liable or responsible for any advice, the course of treatment, diagnosis, or any other information, services, or product you obtain through this article or others.


Mettler FA, Huda W, Yoshizumi TT, Mahesh M (2008) Effective doses in radiology and diagnostic nuclear medicine: A catalog Radiology 248: 254–263.

Tubiana, M., Feinendegen, L. E., Yang, C., & Kaminski, J. M. (2009). The linear no-threshold relationship is inconsistent with radiation biologic and experimental data. Radiology251(1), 13–22


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