Diagnostic Imaging Report

Council on Chiropractic Guideline and Practice Parameters

Lawrence H. Wyatt, DC, DACBR (Team Lead): Professor of Clinical Sciences, Texas Chiropractic College

Dana J. Lawrence, DC, MMedEd: Senior Director, Center for Teaching and Learning, Palmer College of Chiropractic

Timothy Mick, DC, DACBR: President, Imaging Consultants, Inc., St. Paul, MN; Spine Radiologist, Center for Diagnostic Imaging, St. Louis Park, MN

Eugene A. Lewis, DC, MPH: Private practice, Greensboro, NC; Vice Chair, North Carolina State Radiation Protection Commission; Member, Executive Committee, CCGPP

Patrick J. Farrell, DC, DACBR: Chiropractic Radiologist, Farrell Radiology Consultants, Frederick, MD; Private practice, Gaithersburg, MD


The Diagnostic Imaging team was asked to review the literature on the use of diagnostic imaging in chiropractic practice. The literature on this topic is quite extensive. In 2007-8, a series of literature syntheses was published in the Journal of Manipulative and Physiologic Therapeutics on this topic. The diagnostic imaging team, in consultation with the CCGPP, believed that the best course of action was to evaluate this extensive literature synthesis before delving further into the individual papers in the literature base. We would then determine if the synthesis covered those topics of interest to the chiropractic profession in a sufficient manner.


Each of the team members was provided with the following papers (links to full text are provided with permission):

The Appraisal of Guidelines Research & Evaluation (AGREE) Instrument was used in the evaluation of this literature synthesis. In essence, the AGREE instrument is used to provide a tool for assessing the quality of clinical practice guidelines. All authors and the CCGPP were in agreement that this was the appropriate instrument to be used.

Each team member was provided with each of the papers listed above, along with the AGREE instrument via e-mail by the team lead. Each member was to then review the papers and provide an analysis of each based on the AGREE instrument. One member suggested, and it was unanimously approved, that the four papers, although published separately, should be reviewed as one single document. Consultation with the CCGPP affirmed this approach.

After reviewing the literature synthesis, each team member then forwarded his analysis to the team lead, who then collated the results.


The total scores, based on the AGREE instrument for each reviewer were as follows:

Reviewer 1- 68

Reviewer 2- 86

Reviewer 3- 88

Reviewer 4- 72

Reviewer 5- 86

These scores tabulated to a mean score of: 80.0

A score of 80.0 gives this literature synthesis a recommendation of: Strongly Recommend


It is therefore the recommendation of the diagnostic imaging team that the literature synthesis mentioned previously be adopted as the official position of the CCGPP on matters relating to the use of diagnostic imaging in the chiropractic profession.