SYNOPSIS: For healthcare providers involved in the management of patients with musculoskeletal disorders, the ability to order diagnostic imaging is a beneficial adjunct to screening for medical referral and differential diagnosis. A trial of conservative treatment, such as physical therapy, is often recommended prior to the use of imaging in many treatment guidelines for the management of musculoskeletal conditions. In the United States, physical therapists are becoming more autonomous and can practice some degree of direct access in 48 states and Washington, DC. Referral for imaging privileges could increase the effectiveness and efficiency of healthcare delivery, particularly in combination with direct access management. This clinical commentary proposes that, given the American Physical Therapy Association's goal to have physical therapists as primary care musculoskeletal specialists of choice, it would be beneficial for physical therapists to have imaging privileges in their practice. The purpose of this commentary is 3-fold: (1) to make a case for the use of imaging privileges by physical therapists, using a historical perspective; (2) to discuss the barriers preventing physical therapists from having this privilege; and (3) to offer suggestions on strategies and guidelines to facilitate the appropriate inclusion of referral for imaging privileges in physical therapist practice.

J Orthop Sports Phys Ther 2011;41(11):829-837. doi:10.2519/jospt.2011.3556

KEY WORDS: diagnosis, direct access, MRI, radiology, x-ray

A 28-year-old female was referred for enrollment in an acute whiplash research study that involved magnetic resonance imaging. A conventional magnetic resonance imaging scan of her cervical spine was performed by the lead researcher. Upon retrieval of the images by the physical therapist, a bright signal was noted on both sequences within the C6 vertebral body. The images were referred to a neuroradiologist, who noted that the area of concern was an incidental finding consistent with a vertebral hemangioma, which is a benign vascular tumor of the vertebral body. This case highlights the fact that many opportunities exist whereby physical therapists can, and should, correspond with physicians on a level that resembles collegial consultation, whether in the clinical or research setting.

J Orthop Sports Phys Ther. 2009;39(2):149. doi:10.2519/jospt.2009.0402

KEY WORDS: cervical spine, differential diagnosis