5 HOURS X-RAY IN 1 WEBINAR (last updated 30-August-2023):
DIGITAL X-RAY
It is likely that many or most DCs in practice in California went through Chiropractic school trained exclusively in the use of analog (film/screen) equipment; myself included. This is not a bad thing. There is a general feeling on the ‘outside’ that analog-trained operators make the best radiographers because of factoring abilities honed from the direct feedback provided by film images. Digital radiography (DX) is different than analog radiography in several important ways that impact image quality and radiation dose, and profoundly effect the way x-ray equipment is used.
Many veteran doctors are currently in the process of upgrading their image receptors from analog to digital. Some are contemplating what type of DX system to buy. Others have already purchased; sometimes from an equipment vendor sponsoring a relicensing seminar. Doctors are immersed in a bewildering array of misinformation. Those doctors who were never trained in digital radiography may find themselves walking into their offices the day after the equipment upgrade with only a crash course in DX; leaving most questions unanswered. Doctors yet to purchase need general knowledge to point them in the right direction. There are no vendors or "relationships" associated with this course which allows me to be totally honest and unbiased with any equipment recommendations. If you never had training in DX, this course will really "open your eyes."
Recent graduates who will be taking the NEW ARRT-Administered CDPH-RHB Radiography X-Ray Supervisor And Operator Permit (XSOP) exam will be tested heavily on DX. All mention of analog radiography with chemical film processing has been removed from the NEW exam. Though this 5 hour course was not specifically designed to prep doctors for the XSOP exam in the same way as my XSOP exam prep course, all of the material in this 5 hour course is fundamental and required for the NEW XSOP exam. If you are a licentiate in need of a CDPH-RHB Radiography X-Ray Supervisor & Operator Permit (XSOP), and are a little weak in the x-ray technology area, particularly digital x-ray concepts, this course will help you understand a tough subject so necessary to passing the XSOP exam, and give you 5 hours of continuing education to apply to renewal of your DC license.
In conclusion, this webinar course serves several purposes: 1. to provide any California licentiate (MD, DO, DC, DPM) with 5 hours of CA BCE approved continuing education to be used to renew their current CDPH-RHB Radiography X-Ray Supervisor & Operator Permit (XSOP), 2. to provide licensed chiropractors with 5 hours of Board approved general category continuing education to be used to renew their DC license, 3. to provide veteran and new licensed DCs information that can help them better purchase or use digital x-ray equipment, and 4. to provide any licentiate in need of an XSOP basic digital x-ray technology to help study for the XSOP exam and also usable to renew their license to practice. If you are interested, please browse to CONTINUING EDUCATION, SCHEDULE & PRICING, and CONTINUING EDUCATION, REGISTER & PAYMENT to sign up and pay.
X-RAY OF THE CERVICAL, THORACIC AND LUMBAR SPINE
Radiography has a long tradition in Chiropractic practice. The purpose for radiography is to add essential information that will improve clinical outcomes. Patient selection is the most important decision in the plain film radiography process. After a patient has been determined to be a candidate for radiography, the selection of radiographic projections determines the success or failure of the radiographic exam.
Plain radiography is a gross screening procedure with built-in limitations, including low sensitivity and specificity for most early and even advanced pathology. This is due to a combination of factors beginning with a limited ability to resolve inherent subject contrast due to the way x-rays are absorbed and scattered inside the human body. Geometric factors including focal spot blur, magnification and distortion further compromise the radiographic image. Add to that 20% extra-focal radiation, 20-40% scattered radiation, primary beam leak and backscatter, subject and equipment motion and intensifying screen blur; it is amazing plain radiography works at all. The evolution from film/screen (analog) to digital radiography (DX) introduces new elements which can degrade the radiographic image. Since one 2-D radiographic view is generally insufficient, a radiographic set consisting of two or more optimized views must be performed to increase the likelihood of a diagnostic exam.
I am breaking up radiography of the spine into two 5-hour webinars: (1) the cervical spine, and (2) the thoracic and lumbar spine (includes ribs). These webinars define what is the minimum radiographic exam for their respective spinal regions and which views should be added to optimize the exam for different clinical situations. A large number of normal, normal variant and pathology cases are shown in context to demonstrate diagnostic pitfalls from not using the recommended standardized views.
Upon completion of hours 1-5, a doctor will have a renewed understanding of the limitations of plain film radiology of the cervical, thoracic and lumbar spine, and a better understanding of which radiographic views to include to image common pathologies. If you are interested, please browse to CONTINUING EDUCATION, SCHEDULE & PRICING, and CONTINUING EDUCATION, REGISTER & PAYMENT to sign up and pay.
PREP COURSE TO PASS THE NEW ARRT-ADMINISTERED CDPH-RHB RADIOGRAPHY X-RAY SUPERVISOR AND OPERATOR PERMIT (XSOP) EXAM (last updated 28-July-2023): In California a licentiate degree alone (MD, DO, DC, DPM) DOES NOT allow for the use of x-ray or other ionizing radiation on human beings. In California the professional use of x-rays and other ionizing radiation on human beings takes place through a complex system of certifications for both licentiates (doctors) and non-licentiates (technologists). This system is different than in most other states and presents challenges when doctors migrate to California from other states.
In California the only licentiates (MD, DO, DC, DPM) allowed to apply x-rays to human beings are those possessing a valid California Department Of Public Health-Radiologic Health Branch (CDPH-RHB) Supervisor & Operator Permit, or a medical radiologist possessing a Radiology Supervisor & Operator Certificate. The Radiology Supervisor and Operator Certificate is unlimited in scope and available only to medical radiologists and oncologists by a special non-test-based process. There are four (4) different supervisor and operator permits, each with varying lesser scopes, that are granted after a rigorous application and testing process. These four (4) supervisor and operator permits include: 1. fluoroscopy, 2. radiography, 3. dermatology and 4. bone densitometry. From this point on I will only be discussing the CDPH-RHB RADIOGRAPHY X-Ray Supervisor and Operator Permit (XSOP) because it is used by the Chiropractic profession and most other non-radiologist licentiates. A CDPH-RHB RADIOGRAPHY X-Ray Supervisor and Operator Permit (XSOP) allows the licentiate to “perform radiography” and "supervise" one or more non-licentiate professionals to include: certified x-ray technologists (RT) and limited x-ray technicians (XT). X-ray technologists and technicians may practice radiography only under the supervision of a licentiate supervisor and only by written authorization. Licentiate supervisors (licentiates possessing an XSOP) are authorized to both take x-rays themselves and supervise radiography performed ONLY by a certified RT or XT.
Misconceptions about which doctors (MD, DO, DC, DPM) can practice radiography in California are common. The short simple answer is that no doctor of any kind (MD, DO, DC, DPM) may use x-ray on human beings (practice radiography) unless he is also a permitted supervisor (has an XSOP). It does not matter if there is another doctor in the x-ray room who is a permitted supervisor. Supervising a non-technologist practicing radiography is considered by the RHB to be aiding and abetting a crime. Under CCR, title 17, section 30400(38) the "practice of radiography" is defined as the procedure for creating an X-ray image, and includes one or more of the following: (A) positioning the patient; (B) selecting exposure factors; or (C) exposing the patient and the recording medium to X-rays. Anyone who "practices radiography" as previously defined WITHOUT any of the certifications described above (XSOP, RT or XT) has committed a misdemeanor punishable by jail time and fines. Any permitted supervisor aiding and abetting a non-technologist performing radiography has committed a misdemeanor based on CA Health and Safety Code 107110. Quoting: "It shall be unlawful for any licentiate of the healing arts to administer or use diagnostic, mammographic, or therapeutic X-ray on human beings in this state after January 1, 1972, unless that person is certified pursuant to subdivision (e) of Section 114870, Section 114872, or Section 114885, and is acting within the scope of that certification." To "practice radiography" in California, any licentiate (MD, DO, DC, DPM) needs BOTH a current license to practice in California AND a current CDPH-RHB Radiography X-Ray Supervisor And Operator Permit (XSOP). BTW, non-permitted individuals (no XSOP, no RT, no XT) can process the images, or perform the required QC, provided they can document adequate training. However, make sure the non-permitted individual does not slip down the slippery slope to practice radiography (position, factor or fire). If you need to acquire an XSOP, I can help.
Every facility that applies x-rays to human beings must have a certified permitted supervisor available and "on duty" when radiographs are being produced. Each supervisor "on duty" is responsible for all x-ray-related activities at that facility, and is required by law to have a legible copy of a CURRENT XSOP posted on the wall of that facility. The ability to both supervise and take x-rays increases your professional value and status. Many new doctors (MD, DO, DC, DPM) need a XSOP to practice. I have spoken with many veteran doctors who previously had a XSOP, allowed it to permanently expire (either willingly or by not properly renewing), and now painfully regret it. If more than 5 years have passed beyond the expiration date on your last current XSOP, the doctor must re-sit the examination process to obtain a NEW XSOP. The CDPH-RHB Radiography X-Ray Supervisor And Operator Permit (XSOP) is exactly the same for all California licentiates (MD, DO, DC, DPM), and all California licentiates take exactly the same CDPH-RHB Radiography X-Ray Supervisor And Operator Permit exam to get one. Each licentiate (MD, DO, DC, DPM) may use a XSOP only within the scope of their California license (MD, DO, DC, DPM) to practice. This exam is tightly proctored, electronic, and has become more difficult over time. Doctors decades out of school who never liked x-ray physics and protection courses; or Medical, Chiropractic or Podiatric clinicians asked to become the supervisor of a clinic; must now memorize vast quantities of “foreign” material not otherwise usable in their practices.
Only doctors (MD, DO, DC, DPM) already licensed to practice in California may apply for a XSOP. Part of the application process is to include a copy of your California license to practice. If a doctor loses his license to practice in California, he also automatically loses the XSOP attached to it. The CDPH-RHB Radiography X-Ray Supervisor and Operator permit (XSOP) exam process begins by downloading an application form from the RHB and sending it back to them with documentation plus a $127.00 non-refundable application fee. The application process takes place through the CDPH-RHB, but exam development, payment and administration since July 1, 2018 takes place through the American Registry Of Radiologic Technologists (ARRT). After your application is approved by the RHB, you will be directed to the ARRT website where you register, select an exam date and location and pay a non-refundable testing fee of $275.00 (pays for one exam only). An approved application from the RHB gives the doctor a one year window to test, and a doctor may test multiple times during that year. Examinees must receive a test score of 75% to pass the exam. Unfortunately some doctors will have to test multiple times (at $275.00 each) until the exam is finally passed. There is an additional one-time charge of $349.00 for the OPTIONAL ASRT web-based study materials to be purchased at the ASRT (American Society Of Radiologic Technologists) website, after your application is approved by the CDPH-RHB and you purchase an exam through the ARRT. If you think this process is vague and convoluted, get ready to add overwhelmed when you see the immense new ASRT study materials. You can read more about the NEW exam at the following link: NEW EXAM
Previous to July 1, 2018 I gave a comprehensive and effective webinar-based 9-hour prep course to prepare for the OLD RHB-administered exam. It was highly-successful at getting doctors a new XSOP. This prep course included three group sessions, each three hours long. The first two sessions consisted of studying CDPH-RHB materials for two hours, followed by one hour studying test questions. The final three-hour session consisted of blasting through test questions until we completed over 650 of them. Since the format was live webinar, everyone attended live from "home" with their own computer or device, had a mic and speakers (or headphones) and we communicated openly together in real time. Anyone could stop and ask questions at any time. This is very important because even though we discussed a great many questions, there are unlimited variations of each, and not understanding question strategy could result in missing one "almost" the same. Finally, I recorded all three study sessions (all 9 hours) and supplied the recordings to attendees to study from. Repetition of this material is extremely important. EVERYTHING was in the recordings, all discussions and all 650 questions to review. This prep course was open to all licentiates (MD, DO, DC, DPM) who needed a CDPH-RHB Radiography X-Ray Supervisor and Operator permit (XSOP). I completed one final prep course in April 2018 just before the big exam administration change of July 1, 2018. I had a large number of licentiates of all types examining up to the final day. Also on that final day, June 30, 2018, the RHB removed their long-lived free study syllabus from the CDPH-RHB website because of conflicts with the NEW ARRT-administered exam.
Since July 1, 2018 I have been going through the ASRT study materials designed to prepare for the NEW ARRT-administered Radiography X-Ray Supervisor and Operator Permit exam. The general categories that are tested consist of three areas: 1. image production, 2. safety and 3. patient care. I find the new web-based study materials, mostly audio-video presentations that are occasionally changed out, to be interesting, high quality and clearly more comprehensive and difficult than the familiar dated free study syllabus previously supplied by the RHB to prepare for the OLD exam. The sheer quantity of the new study materials will take much more time to go through than the old free syllabus. The ARRT stated that their test questions are created by national panels of experts and that test questions will be changed annually. Most XSOP candidates will not enjoy memorizing the required x-ray physics, protection and ancillary material required for the new exam. A much higher level of professional competency is now expected of doctors seeking to become permitted supervisors. By design the CDPH-RHB (XSOP certificate administrator) and the ARRT (CA XSOP exam administrator) are separate organizations, related only by the testing process. This separation insulates the RHB from 'positive or negative' feedback examining doctors could have about their test results. The function of the ARRT is to test licentiates and send test results back to the RHB. After receiving the test results from the ARRT, the RHB notifies examinees in writing whether they passed or failed the exam.
There is an immense amount of material to memorize to prepare for the NEW exam. Comparing the OLD exam to the NEW exam, one notable difference is that all mention of analog radiography with chemical film processing has been removed and replaced on the NEW exam with sophisticated questions pertaining to digital radiography. There are four categories of questions regarding patient care in the NEW exam that were never covered in the OLD exam. For many reasons my OLD exam prep course had to be discarded and a totally new course had to be created. After two years time and approaching two thousand hours of work I've come away with about 1,400 practice questions plus many targeted study items. I am still editing the materials today and now realize that I will never be "finished". My new course is test question-based to prepare examinees for what they will have to deal with on "test day," and the course is continuously adjusted to mimic the actual exam. Non-question-based study materials on x-ray technology are probably helpful, but they do not prepare candidates for the stress and experience of the actual XSOP exam. This course takes place over four evenings, three hours per evening, for a total of 12 hours. It was necessary to increase the number of hours to 12 because the voluminous new material would not fit into a 9 or 10-hour course. In fact, the most recent recorded course consists of FIVE 3-hour videos plus 24 integrated handouts. "Everything seen and heard" in the webinar sessions is recorded and supplied to attendees to stream from any internet-connected device on your own time. It will take several 'trips' through the materials to get prepared to take the test, but you will have all the materials at your fingertips, and need only spend the time reviewing. If you are interested, please browse to CONTINUING EDUCATION, SCHEDULE & PRICING, and CONTINUING EDUCATION, REGISTER & PAYMENT to sign up and pay. If you need targeted information about the renewal or re-activation of a CDPH-RHB Radiography X-Ray Supervisor & Operator permit, please browse to INFORMATION RESOURCES, FAQS X-RAY SUPERVISOR & OPERATOR PERMIT. Don't worry, I got this! The application process alone to the RHB to begin the official XSOP test process takes thirty (30) calendar days (per their application form) and it can take four (4) weeks for the final test results to pass from the ARRT to the RHB and finally to the examinee!