Technology-Based Chiropractic: Resistance Is Futile!
Written by Patrick Gentempo, D.C.   
Thursday, 28 December 2006 23:05

Dr. Patrick Gentempo, President and CEO of the Chiropractic Leadership Alliance (CLA) and the Creating Wellness Alliance (CWA), is one of the featured presenters at the Chiropractic’ 07 Convention sponsored by The American Chiropractor in The Republic of Panama, Feb. 22-24. His themes of “cutting edge chiropractic success” and “technology-based chiropractic practice” are resonating with many thousands of chiropractors worldwide.

Dr. Gentempo and Dr. Christopher Kent shared a vision, over two decades ago, of a technological revolution within chiropractic. That vision continues to become reality as the Insight surface EMG they first introduced to chiropractic in 1988 has evolved becoming a fully integrated multi-technology platform that will actually calculate a score indicating neurological function of those patients that are scanned. This technology is currently in use on six continents, in many thousands of chiropractic clinics.

In an interview with The American Chiropractor (TAC), Dr. Gentempo shares his views on technology, offering you a preview of what to expect in Panama in February.

TAC: By your interpretation, what is technology-based chiropractic?
Gentempo: Technology-based chiropractic is a model of thinking and practice where the traditional philosophical uniqueness of chiropractic meets 21st century technology and objectivity. When I graduated from chiropractic school in 1983 and started practice, I heard many leaders and mentors claim, “You have to believe in chiropractic or have faith in chiropractic in order to succeed in chiropractic.”

To me, chiropractic is NOT a religion. It shouldn’t rely on faith or belief. However, to practice with the premise that lifestyle stress causes neural disturbance in the form of vertebral subluxation and to recommend care for individuals without spinal pain, resulted in a significant challenge…especially in light of the fact that the majority of clinical evaluations performed by most Doctors of Chiropractic entailed traditional ortho/neuro tests that were designed to evoke pain. How was the DC supposed to transcend the limitations of the back-pain practice? Did their patients have to believe in the benefits of chiropractic also?

Surveys have shown that over 90 percent of our profession recommends wellness/asymptomatic care for their patients and over 88 percent use and recommend that we keep the term vertebral subluxation complex. This challenge caused us not only to create technology, but also training programs to compliment the technology to ensure success.

By now, I am sure most of your readers have at least heard of our four-day practice transformation training, called Total Solution. We have had over 5,000 graduates and it continues to grow each year. The number one reason DC’s come to Total Solution is because they have a back and neck pain practice, but want a lifetime, family wellness care practice. Our Insight technology with our Total Solution training combine to get the DC across that chasm. So, technology-based chiropractic is where the foundations of the practice literally rest: on the use of technology. The DC’s not only use technology as a basis for their care and recommendations—as compared to subjective and unproven assessments, such as orthopedic tests—but also use technology for their marketing, patient education, staff training, record keeping, and even in their adjusting. Welcome to the very exciting 2nd century of chiropractic!

TAC: How do you view CLA’s standards as a company?
Gentempo: Our standards are extremely high. I don’t settle for second best; never did and never will. I am obsessed with utilizing the absolute best technology available in every product we produce. I am also passionate about integration, meaning not only having multiple technologies, but having them integrate properly. Think in terms of a word processor, spreadsheet, database, e-mail and calendar management and presentation software…and then think, Microsoft Office. Integration translates into the whole being greater than the sum of its parts. Some vendors try to offer multiple technologies from multiple manufacturers. It has a cobbled effect that dilutes impact and usefulness. The Insight’s individual technologies shine as they stand alone but, through their integration, they create transcendence. I refer to it as technological poetry. An example of this is the overwhelming market response we are getting to our patent pending NeuroSpinal Functional Index, or NSFi for short. The findings of the Insight’s five technologies boil down to a simple, elegant, easy-to-understand number. With all this testing, the doctor now has one number to communicate and the patient has only one number to understand. It is simple, yet extremely powerful.

We hold several patents on the Insight and have several more pending. In the technology business, this is critical. It means other companies can be in our product category, but they can’t develop or sell what we do, because we have intellectual property protection.

Also, through technological superiority, we bring increased credibility to our clients. The Insight is the only technology in its category to receive certification from the Space Foundation, which was co-founded by NASA! An earlier version of the Insight was used on two shuttle missions and we are currently corresponding with NASA on proposals for new projects on which to collaborate. Our clients are trained to leverage this distinction with a press release and other marketing strategies to the benefit of their practice. When a DC can claim that he or she uses Space Certified technology in their practice, such a statement enhances the perceived value of their services and they, themselves, are held in high esteem by the general consumers.

Another clear standard that CLA has established is that we don’t sell a “machine,” we sell a result. Technology, by itself, does nothing. It is the person who uses that technology that gets the result. We are exacting experts on practice success. We have painstakingly analyzed where chiropractors have struggled, and often failed, and have developed systems of thinking and practice that resolve those issues. The technology is a critical piece to that puzzle. But, if someone is struggling in practice or seeking to move their practice in a new direction, simply adding technology without a strategy and the resulting tactics may compromise their desired result. In this scenario, they’ve now spent substantial money, yet failed to move forward. Our standards won’t allow for this to happen. That is why we have integrated programs like Total Solution with the Insight technology.

So, our standards are simply this: Get our technology, use it, come through our training. If, at that point, it is not right for you, give it back to us and we give you back all your money or cancel your lease. Our standard is that we only want people to win BIG with us, not spend money and get hurt. Our testimonials are strong evidence that our standards separate CLA from competitors, while having lasting benefits for our clientele.

TAC: What technologies have you put on the Insight platform and why?

CLA’s Insight platform utilizes up to five technologies. Surface EMG, infrared thermal scanning, pressure algometry, inclinometry (range of motion), and our most recent and immensely exciting addition, heart-rate variability. We chose these technologies based upon what is most critical for the DC to measure, along with what has the best literature support.

It all started with surface EMG or sEMG, for short. This technology measures patterns of motor nerve activity by looking at muscle energy patterns. There is published research that shows that chiropractic adjustments improve these patterns in a significant and positive way, as compared to controls. Since chiropractors are primarily concerned with the function and performance of the nervous system, it is important to note that the nervous system has three sub-systems: sensory, motor, and autonomic. We think it is critical to objectively and non-invasively assess all three—and we do. SEMG handles the motor portion.

What really excites me is that we have invested considerably in the Insight’s sEMG performance and features. Just recently, we released our newest version that performs full digital signal processing. The new Insight sEMG not only gives you signal amplitude, but also gives you a spectral analysis of each individual static site scanned. I realize I may be speaking Greek here for a lot of your readers, but I am excited because our technology developed for chiropractic is groundbreaking—the best EMG you’ll find worldwide. Not only is it number one in static performance, but the Insight’s dynamic sEMG performance also tops the industry. Bringing greater prestige to our profession is a major part of our company’s agenda.

The Insight’s infrared thermal scanner performs paraspinal thermal autonomic mapping. The autonomic system is the part of the nervous system that regulates one’s organs and glands. Rounding out the three dimensions of the nervous system is our Insight Sensory Sensitivity Mapper, generically referred to as an algometer. With this technology, we can measure and map sensitivity or pain, rather than subjectively recording it. The Insight maps spinal motion with our two-point inclinometer. It is critical, when measuring ROM, that it be done at two points, so that movement artifact can be removed and the clinician can measure pure spinal motion. The Insight ROM tester accomplishes this in groundbreaking fashion.

Last, but certainly not least is our Insight Pulse Wave Profiler, which measures heart rate variability (HRV). HRV is the most exciting new technology in the field of cardiology and, in my opinion, chiropractic. Recently, there has been research published by Zhang and his cohorts that concluded that chiropractic adjustments have beneficial effects on HRV measurements. This is a serious breakthrough! We are talking about the heart. The cholesterol craze has everyone concerned with the health of his or her heart. Imagine measuring the heart, adjusting the spine and then showing beneficial changes in heart function to your patients. The power of this is self-evident. This is why technology-based chiropractic is revolutionary.

To summarize all the Insight’s functions succinctly: We take the patient on a technological journey from pain (algometer), to movement (inclinometer/ROM), to non-symptomatic nervous system function (sEMG and thermal scanning) to whole body health and wellness (heart rate variability). Can you imagine the difference between lifting legs and pushing heads and this? When I graduated from school in 1983, this was inconceivable. Today, with the Insight, it is a reality. Technology is the best thing that ever happened to chiropractic practice.

TAC: What regulatory and research precedents are there for the technologies used by the Insight?
As for regulatory precedents, Dr. Chistorpher Kent and I have been, by far, the most active advocates of sEMG and the other Insight technologies in the profession. We—Dr. Kent more than myself—have helped write the regulations for sEMG in multiple States. We have been involved in writing diagnostic assessment and imaging chapters for a variety of guidelines documents. And, Dr. Kent has written chapters in leading textbooks on sEMG and thermal scanning.

A perfect example of how our years of work in this realm have benefited users of this technology, even if they aren’t our clients, comes from an article you recently ran in your magazine. The interviewee was describing what he referred to as a “landmark case” for sEMG in Florida. In essence, he had a client who purchased his equipment who was denied payment by insurance coverage. As a result, he went to Florida to testify on behalf of his client to help him get paid. The judge ruled in favor of the chiropractor. The funny thing is, if one were to read the Final Order of the Administrative Court Judge, the judge references the sEMG chapter in the Chiropractic Practice Guidelines and Parameters for the State of Florida. Well, Dr. Kent was the principal author of those guidelines. Due to his earlier work, this case was won.

In short, in defense and promotion of this technology, we have been to court, held high-level meetings with third party payers, testified in front of State licensing boards…you name it.

An extremely important regulatory issue is the Food and Drug Administration in the US, Health Canada (the FDA equivalent in Canada) and CE in Europe. You don’t want to even consider technology that has any issues complying with these federal agencies. This is a very tricky, resource-intensive road that some manufacturers don’t properly follow.

For example, if you can’t get a current FDA 510 (K) registration for the product, that lists the product’s name, all the technologies on its platform, and has displayed the intended uses of the technology, which must match up to the way you intend to use the technology, don’t buy it.  Some manufacturers may try to skirt the issue by simply registering with the FDA as a manufacturer, but that does not suffice and is not the same as having the actual device you are purchasing properly registered.

All this legalese could comprise a book.  But, suffice it to say, we are painstaking in our compliance issues with the Insight.  Our exclusive manufacturer has ISO 9001 and ISO 13485 registration that was not even needed to comply—but it puts us at a higher standard.

As far as research goes, the Insight sEMG technology is unique in that its reliability, applications, protocols, indications and normative data have all been published in peer-reviewed journals and are taught at leading chiropractic colleges.  Dr. Kent and I have ten peer-reviewed publications to our credit alone.  Also, I would like to point out that independent researchers have performed and published very impressive research and reliability studies with the Insight.  In one case, we only found out about it after it was done.  Having published reliability studies is a critical credibility factor with clinical technology.  I am proud to say the Insight has many of these.

TAC:  Why are there some detractors out there as to use of technology in the Insight product category?
  Thank you for this question.  What would chiropractic be without detractors?!

Seriously, there are multiple reasons, none of them good.  One is simply ignorance. They don’t know, understand, or have never used the technology.  These people just parrot what others who are ignorant have said.  In addition, there are some informed detractors who, to a reasonable extent, understand the technology.  The problem is they have different views of what the clinical goals for a chiropractic patient should be versus the majority of the profession. If you subscribe to the attitude that chiropractors should limit their practices to a handful of uncomplicated musculoskeletal conditions then, perhaps, for those purposes the technology is inconsequential.  However, if one is looking to measurably improve structure and function, one must measure it.  Hence, the Insight technology becomes a necessity.  Nobody debates that the Insight accurately and reliably measures what it claims to measure.  The only question is, are these measurements of importance to the practitioner, given the clinical goals he or she has for the patient.

TAC:  Lastly, what things should a DC consider when contemplating the purchase of technology?
  I suggest the following:

•    First and foremost, have a clear vision of what impact you want this technology to have on your practice and life.  Believe it or not, we have a lot of DC’s who have purchased the Insight, but didn’t get the vision of the technology till after they came to Total Solution.
•    Have reliability studies and protocols, specifically for the instrument you are purchasing, been published in the peer-reviewed literature?  Is there any university-based research?
•    Does the instrument have the proper federal agency registration (FDA, Health Canada, etc.), as I discussed earlier?
•    What is the company’s and its principals’ reputation in the field? Have they received significant acknowledgements or awards from the field?
•    What type of training and ongoing support can the company offer?  Do they have the resources and expertise to help you overcome your practice challenges or reach your practice goals?

TAC:  Any final thoughts?

  In order for technology to succeed in chiropractic practice, it must serve a specific and meaningful purpose.  When it does, the impact is immensely powerful.  Our profession needs significantly increased credibility and certainty.  The Insight technology does exactly that and I won’t rest till every DC recognizes the power and importance of technology to the future of this profession.  When it comes to technology, I have three words: Resistance is futile!

You may contact Dr. Patrick Gentempo at 1 International Blvd., #750, Mahwah, NJ 07495.  Phone 201-252-3220, Executive Assistant Mike Thompson, Ext. 114;;



Southern California Solo Practitioner Finds RAPID EMR
Written by TAC Staff   
Wednesday, 24 May 2006 11:10

Dr. Michelle Zarzana came to chiropractic later in life than many of her peers, having previously established herself as a marine biologist and researcher and as a teacher. An injury had placed her in extended chiropractic treatment and it was so effective that she enrolled in the Southern California University of Health Sciences, finishing the five-year program in three and one-half years and earning her D.C. degree in 2002.

Dr. Zarzana regards herself as a “progressive” chiropractor, with a mission of getting patients well and maintaining that wellness with a regimen of limited visits for check-ups and reinforcement of her recommended exercise programs.

“Patients get better faster and stay better,” she says. “Once they are released from treatment, I like to see them about once a month for as long as necessary, but not longer.”

In her Long Beach, California practice, Dr. Zarzana normally sees about 30 patients per day in a six-day week – a workload that affords her the kind of time she likes to spend with each patient. Her clientele is weighted towards sports medicine, young athletes and their families, along with the traditional mix of personal injury and workers compensation cases and wellness patients. She employs two massage therapists and an acupuncturist/herbalist.

Like most of her peers, Dr. Zarzana often found herself bogged down in paperwork—handwriting SOAP notes and composing and issuing reports to attorneys, insurance companies, regulators and referring doctors. She tried dictation and outsourced transcription but found the process unsatisfactory, ultimately choosing to be her own transcriptionist rather than suffer the frequent delivery and quality problems. The  paperwork added the equivalent of a full day to her schedule each week.

Dr. Zarzana found her solution at ACOM Solutions, Inc., also headquartered in Long Beach, which was beginning to market diagnostic and document management software for chiropractic offices.

The solution, RAPID EMR, resides on a tablet computer that doctors can  carry in patient visits to streamline diagnoses and SOAP notes recording and later, to automate production and printing of patient reports. The software can also be installed on desktop and/or laptop machines. The RAPID EMR Total Solution includes the wireless-ready tablet computer, the RAPID EMR software suite, a multifunction printer/fax/copier, and a wireless interface card.

Building patient files in RAPID is highly automated. The software features intelligent interactive graphics and checklists for diagnoses, patient progress updates, and it also allows insertion of hand-written input. Doctors can simply tap on an on-screen  diagram point or check-box and associated text within the RAPID system is sent directly to the patient file. Handwritten notes are entered using an “Inking” feature, and external documents such as photographs and accident diagrams can be scanned into the file and automatically indexed.

The array of interactive screens include, among others, Patient Information, Chief Complaints, Range of Motion, Neurology Exam, Orthopedic Exam, Impairment Rating, Narrative Report, Outcome Assessment Reports and pictorial “Helper” screens for the entire body, the muscles, the spine, acupuncture, auriculotherapy and a genealogical tree.

Doctors can select any of four outcomes assessment reports at any point for printing and distribution, and a Microsoft Word-based report generator that operates independently of RAPID enables creation of custom text or reports that reflect an individual doctor’s style and personality.

Dr. Zarzana was not disappointed, for almost immediately she found that she was able to recover the many evenings and Saturdays that she had been devoting to paperwork. She further streamlined the practice with the purchase of ACOM’s Patient Self-Registration module. Now, when a patent arrives for the first appointment, he/she is handed a tablet computer with the file opened, and brief instructions on inputting the information Dr. Zarzana needs to proceed with the diagnosis: nature of the complaint, type of complaint, degree and location of pain, and so on.

“This information starts the file for the initial visit, and on subsequent visits, the patient revisits the file and the various screens and updates his or her condition,” she says. “The responses again go into the file automatically and continue to build it.”

The consistency, clarity and organized presentation of RAPID reports improve patient understanding and, she believes, help to support the prompt payment of claims.

“If the insurance companies can’t see the value of the treatment, they are reluctant to pay for it,” she says. “When you can document what you’ve done, you have a far better chance for uncontested payment. The RAPID reports we supply to referring MDs have actually impacted our credibility. Several doctors have called after receiving their RAPID reports to say that the level of professionalism is not what they are used to seeing from chiropractors. That certainly helps to support a professional image!”

For more information on the RAPID EMR call 866-286-5315 or visit ­

How to Win at Trial with Objective Proof of Your Patient's Injury
Written by Matthew Powell, Esq.   
Thursday, 27 April 2006 02:45

As a personal injury trial attorney, I am frequently asked by other lawyers how I win my cases. They also ask me why they are unable to obtain larger settlements for their clients, like I do? What do I do differently?

The answer is quite simple. You have to show the injury before they (the insurance adjusters or the jury) will show you the money. All too often we, myself included, try to persuade a jury, a defense lawyer or an insurance claims adjuster that our client’s injuries really exist, by relying on the medical records, X-rays, MRI’s and our treating physicians—without success. But now, I have seen for myself how to really “prove” the injury with objective tangible evidence that anyone can understand.

By using the reports generated by the DXAnalyzer© (computer aided X-ray digitizing software) with Flexion and Extension Motion X-ray in combination, I can easily persuade the most skeptical audience about the seriousness of my client’s injuries by presenting clear Evidence Based Objective Documentation.

With the use of Motion X-rays, the doctor can pinpoint the joint with the most damage and, with the DXAnalyzer© software, the doctor can now measure exactly how bad the injury is. Before this technology was available, the whole injury issue was a swearing contest of vague opinions. But now, with the DXAnalyzer© software, the doctor has exacting measurements which the defense doctor cannot refute. Or if he/she tries to argue against the injury, the defense expert loses credibility. The opinions are now gone and replaced with measurable observable injuries.

Here are a few reasons why the DXAnalyzer© reports are an absolute must for every trial lawyer:

• Seeing is believing:  It is hard for non-physicians to understand what my treating chiropractor is talking about and how serious the injury is, if they can’t see the damage.  The report from the DXAnalyzer© software makes identifying and understanding the injury very obvious and simple.

• Credibility builder:  Now we are not just using words to prove our case, we are showing objective measured documentation that removes doubt and skepticism.

• Juries love to look at things, especially scientific things.  Shows like CSI have made everyone a forensics expert.  Give them something to look at and analyze.

• Defense teams love to use the word “subjective.” Defense Attorneys can no longer use the word “subjective” to describe the evidence based objective documentation that has now been placed into evidence.

My testifying chiropractors feel a lot more comfortable on the witness stand explaining to the jury what the DXAnalyzer’s© biomechanical report demonstrates.  It builds the doctors’ credibility, and they find it much easier to testify when they have this powerful objective document to prove their clinical findings and treatment plans.  When they take the stand, it is now show and tell, rather than just tell.

The DXAnalyzer© images make the defense look like they are holding an empty bag.  The jurors think, “Okay, the injured person has shown us proof of the injury; what is the defense going to show us?”  The defense can’t “show” anything.

I used to try my cases by having the doctor stand in front of the jury with a view box, and try his best to show where the injury was on the static X-rays. This is a recipe for disaster. No juror knows what he/she is supposed to see, or what you are talking about and, generally, the plain film static X-rays alone don’t show very much at all to the untrained eye. But with the motion X-ray, objectified with exact computer mensuration, voilá!  We have clarity, understanding, recognition, and a fair jury verdict.

As a trial lawyer, it is my duty to use every reasonable way to prove my client’s case.  I cannot imagine ever trying a case again without using the DXAnalyzer© reports to prove to the court where and how badly my client was injured.  It just does not make sense to try to explain something, when you can show them instead.  It really goes to the old adage, “A picture is worth a thousand words.”

Matthew Powell is a trial lawyer in Tampa, FL, who started his career representing over 20 insurance companies.  After learning the defense side, he quickly found he could not represent insurance companies, and started out on his own to represent injured victims.  He is a frequent speaker and instructor teaching lawyers and chiropractors how to sharpen their skills in trying low-speed rear-end car collision cases.  He has had the honor of obtaining a $1,000,000 verdict for a case the defense described as a minor fender bender.  He can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

For more information on the DXAnalyzer call: 888-668-8728 or go here:

A Big Injury Practice Today
Written by Jeff Cronk, DC   
Friday, 27 January 2006 00:05


oday, it is hard to believe that anyone with a practice that has been around for a while does not have a big injury practice.  That’s right. Let’s say you have 2000 patient files of patients over the age of 16.  Do you realize that, by general statistics in the U.S.A., you should have 100 patients who were in a motor vehicle accident of some kind; and you should have 120 patients who have a work related injury, just out of your 2000 files?  This is from your old files, mind you; this is not from new patients!


Perhaps these numbers surprise you?  Perhaps you are thinking, “No way!”

Well, I am thinking, “Yes, way.”  And I am also thinking, “Are you capturing this for care; and, if not, why not?”

Okay, let’s verify the numbers. The national average for work related injuries is 6.1 cases per 100 fulltime workers; hence, the 120 work related injuries to the 2000 files above.  In Wisconsin, in 2004, there were 213,415 vehicle accidents of some kind and there were 3,933,348 licensed drivers, which means 5% of the drivers that year were in some sort of accident, or your 100 people above.  (This is a State Statistic that will translate into the same percentage nationally.) This does not mean that they all were injured; it just means that they were in a crash of some kind and they should be checked.

Here are some more statistics for those of you who were not moved by the earlier ones.  These numbers would be the same in any state in the country; I live in Wisconsin, so
used Wisconsin’s statistics for auto crashes:

autoaccidentmay• One injury or fatal crash every 13.5 minutes
• One traffic crash every 4.1 minutes
• One property damage crash every 5.9 minutes
• One person killed every 11.2 hours
• One person injured every 9.5 minutes
• One alcohol related crash every 80.5 minutes
• One bicyclist injured or killed every 7.8 hours
• One pedestrian injured or killed every 6.3 hours
• One school bus occupant injured or killed every 34.3 hours

Okay, enough on the statistics; I think you get the point.  Everyday or every week, I am talking to practitioners about their practices and, of course, spinal ligament work-ups for severity of injury through our services at National Injury Diagnostics, Inc. (X-Ray Digitization) It is amazing to me how many of you have really high numbers of patient files and really low injury practices.  I mean, some of you have 5000-20,000 old patient files!  Run the numbers at 10,000 patient files, and you would have around 1100 potential injury patients to treat each year, just from within!!

But, let’s make it smaller.  Let’s say that you have 1000 patient files; this would be 110 potential injury patients to treat this year, from within.  500 files would yield around 55 injury patients, and I think you get the point.

Okay, so are you getting these kinds of numbers from your already existing patient files?  I would say that you probably are not; however, that is what is there!  So, if that is what is there, why aren’t you getting this?  Could you use, say, 18 re-activated PI or Work Comp cases a month out of your already existing patient base?  What would that do to your practice this year?  What would that really do to your income this year?

Let’s say, you had 200 injury patients this year at say a very low $3000 case average.  That is $600,000 in revenue to your clinic. Now, put the case average to $6000 and have some fun: $1,200,000 in services rendered.

That is your potential in injury work and more, and I do not care if you have a total wellness clinic, if you have files of adults that you have treated over the age of 16, then run the numbers, because the numbers will tell you what you have in potential injury work, period.

Now, let’s say, you are not getting the numbers of people that you have already seen at one time or another for some problem, coming back to your clinic for injury assessment when they are in a vehicle crash or have a work related injury?  What do you do?  What can you do?

The first thing to know is that is that you must understand and become more of a professional at handling the injured patient—a real pro at diagnosis, treatment and management. The patient is in an auto accident, torn up pretty badly and you handle them the same way you handled them when they came in three years ago because their neck was sore from sleeping on a couch. Wrong:  same consultation style, same exam procedures, same X-rays, same report of findings…wrong perception.  Do this and you will not get the patients out of your database who are injured and those numbers will be low.  I guarantee it!

When you are going to change and grow, you must understand where you are weak and where you are strong so that you can strengthen your weaknesses.  The spine has four tissues: bone, nerve, muscle and ligament.  Think for a minute and I know you will see that you have a strong assessment procedure for the bone (misalignment on X-ray), muscle (muscle testing and palpation), and nerve (neurological exam)—but what about the spinal ligaments?  How do you assess what has happened to the spinal ligaments?  A positive break in Georges’ line is what a lot of us use to indicate spinal ligament trauma, but is it a mild break, moderate break, severe break—how do you quantify it?  X-ray digitization completely and accurately quantifies this, and compares the normal to the AMA Guides to the Evaluation of Permanent Impairment established numbers for spinal instability.  This is the most powerful diagnostic tool in trauma practice today, and it turns your current weakness into a powerful strength.

Patient’s who have injured their spines are different from patients who have regular misalignment problems.  Do not treat them the same, as it completely minimizes their significance and minimizes your professionalism, since they are not the same.  Test your trauma patient’s for ligament instability, which shows up as “alteration of motion segment integrity.”  This is not only a serious ligament condition; it is also a ratable ligament condition listed in the AMA Guide to the Evaluation of Permanent Impairment.  Utilize and understand how to accurately determine what is right in front of you on your patients’ X-rays.

X-ray digitization is an appropriate diagnostic procedure to incorporate and, if you do not understand why or how, you need to spend some time and study it more closely. If you need other tests, learn about them and use them.  If you need an MRI to rule out the disc, have the patient get it under your direction.  Know what electro-diagnostic testing with a neurologist can provide, as well as the many other testing procedures. Develop special exercises specific to injuries of the spine.  Develop nutritional guidelines for the injured patient.

Learn about ligaments and how to diagnose, and treat them. X-ray digitization is the most powerful clinical tool in trauma practice today, because it provides you with a way to diagnose spinal ligament trauma.  Incorporate its usage of X-ray by utilizing an outside service or buy an X-ray digitization system and do the diagnostic testing internally.

Become an injury specialist, perhaps not overnight, but little by little, one or two steps at a time.  As a matter of fact, look at those statistics again and then figure again, in your own patient base, what you are missing?

Incorporate spinal ligament testing in your practice today and let your patients know that you are and injury specialist!  Communicate to them in newsletters and keep yourself on the top of their minds as the place to go to when they are injured.  When you use an X-Ray Digitization service, let them know that they have a baseline now set up and that, in the future, when (not if) they are injured to return to you for an assessment.  Take responsibility for the patients that have been treated in your clinic; and part of that responsibility is to help them when they are injured, as they are going to get injured!

Dr. Cronk currently owns and operates National Injury Diagnostics and can be contacted at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or 715-833-8533.

Weighing the Costs Between Standard Film or Computed Radiography
Written by Fred Fischer   
Wednesday, 26 October 2005 21:30

Chiropractic offices have traditionally kept pace with other medical practices in their use of technology. From patient records to billing, many chiropractors are better managing patient care, thanks to evolving technology.  More and more technological advancements are making their way into chiropractic practices. Today’s technology is not only streamlining chiropractic office administration, it’s arming these practices with better diagnostic tools. 

Weigh Costs vs. Savings

Switching from traditional X-ray films to a digital or computed radiography (CR) scanning system whose advantages are vast may seem enticing, but the bottom line questions are still, “Is such a system affordable for my practice?  Will the benefits outweigh the costs; and how long before I can recoup my investment in a digital system?”

Prices are coming way down and that has helped make the up-front investment more affordable for more and more chiropractors.  The new systems are suitably sized and priced for the private office.  That fact, combined with the long-term savings to be realized from the elimination of disposables such as film and chemicals, as well as freedom from frequent maintenance and waste disposal, makes the transition to digital an attractive proposition worth serious consideration.

In addition to doing away with X-ray film, costly chemicals, hazardous chemical disposal and film processor maintenance and repairs, digital imaging eliminates the need for sizeable film storage facilities and a dedicated darkroom.  The space savings alone provides a valuable advantage, allowing you to reclaim precious room that can be utilized for patient care.  The annual savings for a practice that takes as few as eight films a day can be as high as or even higher than $9,000 after switching to digital.

So, where does that leave you on the cost side of the equation?  Until very recently, digital and computed radiography imaging systems were priced well out of the reach of the average chiropractic office.  Today, however, there are a number of companies offering these systems that provide all of these advantages at a much more reasonable price.

Realistically, you are looking at an investment of between $32,000 and $40,000 for a computed radiography scanning system.  So, if you are taking eight or more films a day and saving approximately $9,000 every year (see chart), that means that, over the course of four to five years, you will have paid for the system with the savings.  From that point forward, you can start banking the savings. Obviously, a practice that is doing a larger number of daily X-rays would reach a breakeven point more quickly and recoup the cost of the system faster.

How Does CR Work?

The CR processor uses a special re-useable imaging plate containing photosensitive storage phosphors that retain the image until it is sent to the computer. These plates can be reused thousands of times before being replaced. X-rays are taken in the usual manner. The plate is then removed from its cassette, inserted into a scanner where the image is scanned, and automatically transferred to your computer in less than a minute. You’ll know right away if you need to take another view, so there’s less waiting for you and the patient.

Great Patient Education Tool

The beauty of digital is in the fact that you can enhance the image to bring out diagnostic detail.  You can magnify, heighten contrast, and even colorize the affected area.  It’s a great way for chiropractors to educate their patients about treatments and better demonstrate a misalignment or disk problem. For example, you can do a side-by-side comparison with a prior X-ray to show positive therapeutic changes. Your patients will actually be able to see, as well as feel, the physical improvement after treatment.

Dramatic Decrease in Need for Retakes

You have greater latitude in getting good readable images.  Digital is much more forgiving of exposure errors because it has a wider dynamic range than film.  If an image is under or over exposed, the computer can adjust for the error and provide a very useable image.  With film, an error in exposure often means that the X-ray must be repeated, which means that the patient must be irradiated a second time.  This is not only inconvenient, but results in unnecessary added radiation exposure. With digital, there are significantly fewer retakes. 

Is CR Right for Your Practice?

Computerized radiography offers the advantage of quick image access and does away with the need for stockpiling, searching and copying films.  All images are saved for easy retrieval on the computer system and stored on secured backups.

You can transmit digital images electronically in an instant to a colleague across town for consultation or diagnostic confirmation.  The image can be e-mailed while the patient is still in your office. If a patient wishes to have a copy of his or her X-rays, the images can simply be burned onto CD’s in a matter of minutes for just pennies. Simply hand the CD to your patient to take with him.

In addition, CR is a superior method of radiography because it’s faster; you can shave 10 to 15 minutes off a patient’s office visit.  Plus, digital images can be enhanced for greater clarity so that more diagnostic information can be derived from them.  Also, instead of manually drawing measurements directly on the film using a ruler and protractor, the computer can be programmed to automatically provide accurate measurements for you.

The use of computed radiography eliminates concerns about environmentally hazardous chemical waste disposal.  Across the country, government regulations continue to make disposal increasingly more costly and difficult.

Select the Right System and Service

If you do decide that your office could benefit from the advantages of computed radiography, make sure that you research not only the systems, but also their customer support.  As a new user of unfamiliar technology, the technical assistance, training and service a dealer and manufacturer can provide is critical.  While it’s easy to use, you and your staff will still need to learn how to adjust to and use the new equipment, and you’ll want to be able to quickly troubleshoot problems and get answers right away.  Make sure the manufacturer provides excellent customer service.

Many of today’s newer offices are fully computerized and are starting out paperless and filmless.  But practices with existing film radiography in place have to weigh the benefits of digital against its costs.  If you are doing a considerable amount of scans each day, then the advantages of switching are obvious; but for those practices that take less than five scans per day, the decision may be less focused on savings and more on getting faster, better results and maintaining a cleaner environment.  CR provides the practitioner with a paperless office where images are conveniently stored with each patient’s file on the computer hard drive and in backup systems.

Since 1985, Fred Fischer has been the senior executive at ALLPRO Imaging, a manufacturer of X-ray equipment for the medical profession. The company was founded in 1962.

Fred Fischer has been the senior executive at AllPro Imaging, Inc., a manufacturer of X-ray equipment for the medical profession, since it was established in 1985. A native of Hollywood, CA, Fred is a graduate of Manhattan College with a degree in electrical engineering. After his discharge from the service, Fred worked as an electrical engineer at RCA Corp., and was later a salesman for the Electrodyne Division of Becton Dickenson Corp.

For more information about ALLPRO and the ScanX 14, call Linda Schutt at 516-214-5611 or e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it . Also, visit ALLPRO’s website at


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