A Little Bit About DMX, Digital Motion X-Rays
In this article I want to talk a little bit about Digital motion x-rays or DMX. There’s a lot of information out in the market regarding DMX, most of it coming from the providers who have DMX units in their practices.
So, let’s talk about what DMX is.
First, DMX is not a primary imaging tool, it is a secondary x-ray imaging tool.
It is a tool that is usually used by chiropractors and is often used only in the neck. This is because the output of a DMX machine is not strong enough to image the lumbar spine region. This means that DMX can’t really do anything for a patient suffering from chronic low back pain. And as we continually reference, ligament injuries to the lumbar spine are the number one cause of chronic pain and disability in the world today.
Since these injuries cannot be assessed by a DMX machine, DMX does nothing to solve one the the biggest problems in the spinal injury market. The DMX is limited to being a cervical spine injury tool.
To my knowledge there’s only around 200 DMX units in the United States.
Even with this low relative number of machines the providers who use them can be quite vocal about their efficacy. I read and hear them talk a lot about the fact that they’re so much better or more significant than regular x-ray.
I must take issue with this unwarranted criticism of x-ray.
X-ray is the number one primary imaging tool in America for ligament injuries. It is by far the best primary imaging tool in the country. When used properly, it picks up better than 95% of what is needed to make a good spinal ligament injury diagnosis.
I don’t really have an issue with the idea of DMX itself. My only real problem is the providers that use it run down x-ray and that to me is problematic and causes confusion in the market, potentially causing harm the millions of patients that suffer from these injuryies every year.
X-ray is cost effective and uses a lower dose of radiation. Since DMX is a secondary Imaging modality to be used 4-6 weeks after that injury, the treating provider cannot get key information about ligament assessment right away with the DMX. With x-ray you don’t have to wait. It’s not a secondary imaging tool. It’s a primary tool and most findings that you will see on a DMX are found on general digital x-rays.
I don’t care if you use DMX. DMX is what it is. If you want to expand the science of DMX, I have no problem with that. Just don’t run down digital x-rays, because they are highly effective and everyone in the country has access to them.
What you’re going to find on the DMX you’re often going to find in a general x-ray study.
X-ray is the best tool in America for ligament assessments. So, SmartInjuryDoctors® know that with basic ligament testing, basic x-ray, and a really accurate intersegmental motion study, you’re going to pick up the majority of severe ligament damage and injuries that most patients in the injury market are suffering.
That’s why I’m a huge proponent of x-ray. I’m not antagonistic or against DMX by any means. Again, I’m only against providers who use DMX as an opportunity or platform to run down regular digital x-ray and say that somehow these x-rays are so deficient. They also tend to say that one of the things that comes up in DMX is that there’s bad movement patterns that occur mid-movement in the patients range of motion. This is something that tends to be promoted a lot but is very difficult to see.
As a doctor who’s been doing ligament testing for a long time. Probably more years than anyone else currently active in the injury market today. I have probably been involved with the measurements of more studies than anyone in the country today and I’m going to tell you that that I’ve never seen these phenomena of mid-motion translation patterns that do not show up on end range motion.
This is a common thing that DMX providers like to talk about, in order to sell the idea that it is superior to digital x-rays. They openly will say that they’ve done hundreds or that they’ve seen thousands of these of mid motion problems that do not show up at the end range of motion with general x-ray. Yet I’m in the market, and I’ve asked for some examples, show me 10 or 20 of them out of these hundreds or thousands that are out there, and I never get any help finding them.
We have even asked to independently measure these images, which have inherent difficulties to compare the digital x-rays because of the differences in the output of the image formats of each.
I have never been able to get my hands on images that show this and again I have done a lot of them and have never seen this phenomenon so it cannot be common.
So, we’ve simply not seen it. In fact, I’ve ran a two national spinal ligament testing companies for a lot of years and I’ve never seen it in a DMX study. Ever. It can’t be common, that’s all I’m saying. I am also not saying that it is not there, I am just saying it is not common.
What I’d like you to understand is that in many ways digital x-rays are by far superior in my experience.
All digital x-rays are in a format called DICOM. It’s an easy to use format and virtually every radiologist in the world is familiar with it and can read these x-rays.
DMX on the other hand is not in standard DICOM format. Which means that most radiologists cannot work with it, so it does not scale as a broad based solution to the epidemic of spinal ligament assessments needed to meet today’s market need.
This makes x-ray a far more accessible tool than DMX in my experience.
With x-rays being a DICOM images, they’re also much easier to accurately measure spacial relationships such as excessive motion. You can calibrate a DICOM image and make incredibly accurate measurements from them. With DMX this is much more difficult since it is not in the DICOM format.
Now the thing I want you to walk away with today is that SmartInjuryDoctors® know they can use good x-ray studies to do 99% of all ligament injury assessments. This is not the standard in today’s injury market. Too few doctors are able to do a standard spinal instability work-up.
Sometimes we do need a secondary imaging procedure.
Secondary imaging procedures that I like best are the MRI.
If you are not picking up an injury on a standard x-ray then to me, the next logical step is an MRI. If you’re a DMX user who has a really good understanding of DMX and you’ve already tested everything with a standard x-ray and you believe that you have missed something with a standard x-ray and you document clearly what you believe was missed and what you are now trying to rule in or rule out, then I am a huge fan.
I’m all for this type of use of a DMX image, to supplement standard x-rays when the doctors feels and clearly states what he or she is trying to accomplish with the imaging.
But don’t tell someone like me, who’s been doing x-ray studies successfully for years that the x-ray is deficient and missing so much, as that has not been my experience at all. That’s what I don’t like about the trend around DMX. It tends to run down x-rays, and the experts in the field who’ve been using x-rays to make credible, accurate ligament injury diagnoses for years. These doctors get incredible results for their patients and should not be run down this way.
That does not sit right with me and that is what I protest in the the small niche called DMX. Please remember that DMX studies probably in any given year represent 0.00006% of the x-ray studies performed in the us. I took liberty to show a very small percentage as a guess just to show the reader that this is a very small niche.
I’ve written other articles and talked on my podcast about ICA best practices for x-ray. The standard digital x-ray is still the number one primary imaging tool available for ligament injury assessments. We do not need other modalities like MRI, DMX, and CT being used to run down the x-ray when the x-ray has so much data in it.
We just need doctors who can mine the data in x-rays properly and then clinically correlate it. That is what will help to eradicate the epidemic of chronic pain resulting from these injuries. That is what we are doing in the SmartInjuryDoctors programs.
For more information on Spinal Ligament Injuries please check us out at www.smartinjurydoctor.com or check out our SmartInjuryDoctors® Podcasts on Apple Podcasts, Spotify, Google Play or Stitcher.
For information on spinal ligament testing by board certified medical radiologists go to www.thespinalkinetics.com
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