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The Spinal KineticsApr 25, 2024 5:00:00 PM4 min read

CRMA™ Report vs. ER X-Ray: Precision in Patient Diagnostics


In the ever-evolving world of medical imaging, distinguishing between various diagnostic procedures and understanding their unique benefits is crucial for healthcare providers. Today, we delve into the intricate differences between CRMA™ Reports and standard X-ray interpretations, especially with emphasis on the Emergency Room Read.

The Overlooked Importance of Stress Imaging

In the acute setting or during preliminary assessments, it is standard practice for patients to receive a comprehensive suite of radiographic examinations, often encompassing stress or flexion-extension radiographs. However, this protocol seldom incorporates stress imaging of the upper cervical region to scrutinize the integrity of the craniocervical junction—an area pivotal to the evaluation of cervical injuries congruent with the profile of patients presenting with Mild Traumatic Brain Injuries (MTBI). Regrettably, this omission frequently results in the oversight of critical injuries within this demographic, underscoring a significant gap in the current diagnostic approach to trauma care.

Rapid Assessments vs. Detailed Ligament Injury Assessments

In the discourse on radiological examinations and the interpretation of X-ray images, the expertise and pivotal role of radiologists cannot be overstated. These specialists, through extensive and focused training, have honed the ability to swiftly evaluate X-ray images, identifying salient abnormalities such as fractures, infections, or pronounced degenerative changes among other skeletal pathologies within moments. This rapid assessment primarily targets the identification of overt pathologies, rather than the intricate details critical for certain diagnoses, including ligamentous injuries or evaluations of spinal stability.

For these more nuanced analyses, particularly those requiring assessment of spinal ligament integrity, additional procedures involving extensive motion testing are imperative. Such evaluations cannot feasibly be conducted within the typically brief duration of an X-ray review, often under a minute. This necessity underscores the indispensable role of comprehensive motion studies. Without these detailed assessments, the condition of the spinal ligaments may remain undiagnosed, potentially overlooking serious conditions that meet the criteria for spinal fusion surgery as delineated in many insurance providers' guidelines for spinal fusion.

The Nuances of Diagnosing Spinal Injuries

Contrastingly, the intricate scrutiny necessary for the identification of ligamentous injuries or nuanced indicators of instability, especially pertinent to cases of spinal trauma, mandates a more detailed evaluative process than what is typically feasible in the rapid assessments characteristic of emergency care settings. These nuanced details are crucial for the accurate diagnosis and subsequent development of treatment strategies for individuals with spinal injuries. Given that the spine's architecture comprises primarily bone and connective tissue, a comprehensive diagnostic approach is essential. Beyond the swift evaluation of bony structures typically conducted by radiologists during a standard X-ray review, a thorough radiographic examination is requisite to ascertain damage to the spinal support ligaments. Additionally, an MRI review is often necessary to evaluate any harm to the spinal discs, thereby providing a holistic understanding of the spine's integrity and informing appropriate clinical interventions.

Technological Advancements in Diagnostic Imaging

Moreover, the introduction of digital imaging technologies and advanced software has revolutionized the field of radiological diagnostics. Artificial Intelligence (AI) now enables the scaling of evaluations for spinal support ligaments, transforming it into a critical assessment for anyone suspected of having ligamentous damage to the spine. Prior to these technological advancements, a radiologist was required to manually identify approximately 211 points on key radiographic landmarks for each study, translating into the laborious task of pinpointing over 211,000 points for every thousand studies conducted. This process was not only time-intensive but also prone to human error.

The integration of AI and machine learning has significantly refined this procedure by automating the identification of these critical points, thereby reducing the potential for human error and drastically cutting down the time required for each assessment. Radiologists are now primarily tasked with making adjustments in instances where the AI's determinations are found to be inaccurate. The advent of AI in spinal diagnostics represents a monumental leap forward, making comprehensive spinal assessments more accessible to patients who have sustained injuries. Additionally, the use of AI is poised to considerably lower the costs associated with these diagnostic tests as their utilization becomes more widespread. Perhaps most significantly, the precision and reliability of these assessments are expected to improve with the accumulation of data from more studies, thereby enhancing the reproducibility of the tests and contributing to better patient outcomes.

Advocating for Independent, Unbiased Evaluations

For chiropractors and other healthcare providers who conduct their own X-ray readings and analyses, adopting the practice of incorporating unbiased, third-party assessments for excessive motion studies is recommended to become a standard protocol. The rationale behind employing an independent third party to conduct these studies lies in the elimination of provider bias. This approach ensures the objectivity of the evaluation, preventing any potential manipulation of study results that could depict a patient's condition as more severe than it actually is, possibly leading to the recommendation of unnecessary care or procedures. Optimal practice dictates that these spinal excessive motion studies should, whenever possible, be performed by an impartial third party that possesses extensive experience in executing such assessments. This not only guarantees the integrity of the diagnostic process but also upholds the highest standards of patient care by ensuring that treatment recommendations are based on accurate and unbiased diagnostic information.


Within the domain of medical imaging, the contrast between rapid scans and comprehensive Computerized Radiographic Mensuration Analysis (CRMA™) reports underscores the critical need for precision and objectivity. As we strive to elevate the standard of patient care, particularly for individuals afflicted with spinal injuries and associated Mild Traumatic Brain Injuries (MTBI), the deployment of sophisticated diagnostic instruments becomes imperative. This dedication to meticulous accuracy not only enhances the quality of patient diagnostics but also reaffirms our commitment to maintaining the utmost standards of diagnostic excellence in the medical field. By doing so, we help doctors to be able to provide more appropriate and effective treatment plans, leading to optimal patient outcomes.