Motion X-Rays

Don helped pioneer the use of motion x-rays as evidence to help objectively quantify permanent injuries. He won the first appellate decision recognizing motion x-rays as merely a new use of old x-ray technology, and allowing Arkansas juries to consider motion x-ray evidence when making their decisions.

Motion x-rays are nothing new. A type of motion x-ray called “Digital Motion X-Ray,” or “DMX,” is a trade name for fluoroscopy, also called video fluoroscopy or cineradiography, which has been around for decades. Medical doctors have used motion x-rays for years to diagnose ligament injuries in the neck. For instance, an article published by medical doctors over 50 years ago in the Journal of the American Medical Association, concluded:

A history of the use of fluoroscopy, and a full bibliography of studies on the technology, can be found here. An example of a DMX study is below:

Injury victims must prove the the nature, extent, and duration of their injuries in order to be made whole in court. Before motion x-ray technology became available to assess ligamentous stability, it was difficult to prove some types of ligament injuries with static x-ray, MRI, and CT. Now, with motion x-rays, physicians can actually see abnormal motion and zero in on damaged areas. This objective evidence helps treating physicians identify the area to treated, and recommend targeted treatment protocols.

History of Motion X-rays

The first x-ray was invented in 1895 by Wilhelm Rontgen. In 1896, Thomas Edison continued to develop radiography with the invention of fluoroscopy to show moving x-ray images on a screen. These fluoroscopy methods evolved and were called cinefluoroscopy, cineradiography, video    fluoroscopy (VF), and now DMX, which all have the same meaning. As technology progressed, the ability to record x-ray motion images evolved from movie film to videotape to digital images, exactly like traditional cameras moving from 35mm film to digital images. Motion x-rays are also similar to MRI and CT digital images in the sense they can be saved on electronic media and displayed on computer screens, or printed on film or paper.

Why is it important to use motion x-rays in spinal ligament cases?

Motion x-rays are a medical break-through to objectively demonstrate the functional loss caused by impaired joints of the spine due to permanent ligament damage. Motion x-rays are the best objective test because normal MRI testing is primarily concerned with static imaging of intervertebral discs and nerves, not ligaments. There are also no discs in the upper neck, which is held together with ligamentous connective tissue. Imaging this area of the body is difficult on static images. Motion x-rays are a useful tool because it images the head in motion, and shows if there is abnormal function of the joints. Motion x-rays are also used as a screening tool when performing proton density MRI and functional kMRI imaging, which are capable of showing injuries to some of the individual spinal ligaments, and are different than a normal MRI.

Motion x-rays are much improved technology over traditional plain film x-rays because it may demonstrate clinical spinal instability due to abnormal joint motion caused by ligament damage. At its heart, motion x-rays are a simple x-ray. However, it works with a video camera to take 30 individual x-ray frames per second  to create a motion x-ray lasting approximately 90 seconds. The video images are made as the patient’s head is moved through nine ranges of motion in a normal, weight-bearing posture, which provides an assessment of all 22 major ligaments in the neck. This results in about 3,000 individual x-ray images capable of being viewed on a computer monitor, freeze framed, zoomed in or out, or viewed in slow motion. The individual images best demonstrating the damage may be saved as static x-ray images by the reviewing physician, and then analyzed using x-ray digitization software.

While ligaments themselves are not shown on the x-ray images, the effect of injured ligaments can be determined by abnormal movement of the individual neck bones in relation to each other. An analogy is to watch leaves blowing in a tree. For example, we cannot visually see the wind blowing, but we can see the effect of the wind because the branches an the leaves are moving. Likewise, even though we cannot see the ligaments in the neck, we can see the results of ligamentous injuries by abnormal movement of the bones in the neck, which is easily observed by anyone trained in musculoskeletal radiology using standard radiology practices.

Who has approved the use of motion x-rays?

The use of motion x-rays was approved for patients with spinal and peripheral joint disorders by the U. S. Food and Drug Administration in 1994, the Arkansas Department of Health and Human Services in 2003, the American Chiropractic Association Council on Diagnostic Imaging  Physicians, the Arkansas Board of Chiropractic Examiners, the Arkansas  Chiropractic Society. Motion x-rays were endorsed by Pain Management, a Practical Guide For Clinicians by the American Academy of Pain Management, Occupational Medicine Practice Guidelines by the American College of Occupational and Environmental Medicine, and further supported by a large number of peer reviewed medical articles published in Spine and other medical journals.

The widespread acceptance of motion x-rays are also shown by being at the top of the list of five approved imaging methods, ahead of MRI and CT imaging, for a Medicare documentation requirement to establish a spinal subluxation diagnosis for a patient before a chiropractic physician can be paid for treatment by Medicare.

Other benefits of motion x-rays

There are other benefits of motion x-rays in addition to showing function of the cervical spine through motion testing. Motion x-ray images have an enhancing effect by showing the cortical margins of the bones in black. In other words, in a digital x-ray of an egg, the shell of the egg appears black, and the contents are grey. This  allows the interpreting physician to detect compression fractures, which are occasionally missed by traditional x-ray. Plain film x-rays do not show some fractures as well, because the cortical  margins are displayed as white, and the body of the bone is also shown as white, thus detecting abnormalities is harder when looking at a white on white image on plain x-ray. Another benefit is motion x-rays only expose the patient to a low dosage of radiation because it uses a low powered  pediatric type of x-ray machine, which is good for imaging necks, temporomandibular joints, and extremity joints; but does not have enough radiation power to image the low back unless the patient is a child or  small adult person.