The Orthospinology procedure is one of only a few techniques within the chiropractic profession that attempts to quantify the misalignment component of the upper cervical Subluxation complex. To do this as reliably and accurately as possible, the equipment used for imaging the upper cervical spine must be aligned properly to minimize distortion. This chapter will explain the detailed process of selecting and aligning appropriate X-ray equipment. The procedures and equipment necessary to minimize radiographic exposure to the patient is reviewed as well. It is also necessary to remember to keep radiation exposure to as low as reasonably achievable (ALARA).

The basic equipment required for radiographic imaging in an Orthospinology practice includes:

The most common generator is the 300 milliamperes (mA)/125 kilovolts peak (kVp). Other models to choose from would be 400 mA/125 kVp, 500 mA/150 kVp, and 600 mA/150 kVp. With the advent of high-frequency generators, the radiographic process has become much more reliable and reduces radiation exposure to the patient by up to 50%. The 300 mA/125 kVp is usually sufficient for a private practice.

Special X-ray accessories are necessary to practice upper cervical chiropractic based on the Grostic model and to align the X-ray equipment. Some of the accessories that will be needed are:

These items will be used in the alignment process. An L-frame or double L-frame is very beneficial and is recommended, but it is not an absolute requirement. Alignment of the X-ray equipment reduces radiation to the patient, minimizes distortion, and improves image contrast. This chapter will outline the steps necessary for self-installation, but some X-ray companies—like American X-ray Corporation in Knoxville, Tennessee—use a laser alignment method that can save the new practitioner many hours of Work setting up the appropriate equipment.

When choosing an automatic processor, be sure to check for quality as well as price. It behooves the doctor to find a high-quality X-ray processor, change the chemicals frequently, and have a scheduled regimen for cleaning it. It is normal to have the processor cleaned at least every 60 days; however, chemicals should be changed at least every 30 days. Increasing radiation to the patient because the X-ray processor chemicals are weak is not appropriate. The Orthospinology procedure requires reliable identification of specific osseous landmarks, which demands a high-quality imaging process while complying with the ALARA philosophy.

Designing the X-ray room is a very important step for the new practitioner. Nine-foot ceilings are preferable. A 14- to 15-foot horizontal wall space is minimal to achieve a 72-inch Focal film distance (FFD), place the transformer, and attach the wall mount for the grid cabinet. Lead shielding in the walls is required for an X-ray room, but the doctors should check with their own state regulations. It is recommended to have a radiation physicist do a “plan and review” to meet the specific state requirements. Note: Be careful in purchasing used equipment. Make certain it conforms to state and federal radiation control laws. If in doubt, check with State Department of Public Health, Division of Radiological Health.

Mounting research indicates that the upper cervical Subluxation complex is a clinical entity that has a measurable osseous component. The atlas vertebra subluxates around the occipital condyles to the right or the left of a Hypothetical normal. It can rotate beneath the skull on the side of lateral Subluxation in either the anterior or posterior direction. Chiropractors need to be able to determine the direction and magnitude of relative alignment in the upper cervical spine. The radiographic process creates a shadow of a three-dimensional object, compressing it into two dimensions, and much information is lost. This necessitates the need for proper X-ray equipment alignment. The chiropractor needs to be able to reliably detect changes in upper cervical alignment of approximately 3/4°. That is slightly less than 1 millimeter in Linear measurement. When purchasing the X-ray equipment, make it immediately known that payment will not be made for equipment that does not conform to the Orthospinology standards. Put it in the sales contract before making a down payment. Having equipment that does not meet minimum standards will inhibit the doctor from measuring relative vertebral alignment with any degree of Validity.

The very first step in the Orthospinology procedure is to align the X-ray equipment. When having someone do a build out in a leased office space or when building an office, make sure that the walls in the X-ray room are at perfect 90° angles and plumb. With the introduction of the L-frame, this requirement is not as important. If an L-frame is not used, the accurate construction of the X-ray room walls will save a great deal of time in the future.