PostureRay®: Now With Added Scoliosis Functionality

Scoliosis has been traditionally defined as a lateral curvature of the spine greater than 10° using the Cobb methods of analysis. Scoliosis plagues not only children but the adult population as well. According to authors such as Weinstein et al, adolescent idiopathic scoliosis (AIS) affects 1-3 percent of children in the at-risk population of those aged 10-16 years.2 Concerning adult scoliosis, Schwab et al.1, concluded a prevalence rate of up to 68% in the population with an average age of 70.5 years. The National Scoliosis Foundation website estimates that in the United States, scoliosis affects 2-3% of the population or approximately 6 million people. In a recent publication, Wong et al.3 state, “Early detection by comprehensive screening programs enables early institution of conservative treatment, with the aim of reducing the number of patients with curves reaching a magnitude that requires surgical treatment.” While it is not the purpose of this article to detail the natural history or the various types of scoliosis, it is our purpose to call attention to the fact that doctors often do not adequately measure, monitor, and possibly treat such deformities when indicated. We believe that the only valid measure for doctors to detect early onset of scoliosis is not external, but rather with x-rays. As such, chiropractors should take their rightful place in being part of the solution for conservative treatment and management of scoliosis cases when surgery is not indicated.
Traditional marking of x-rays by hand is very time consuming for the busy clinician. Fortunately, you now have an easy tool to use which not only measures these displacements, but at the same time educates and monitors scoliosis patients: PostureRay®. Since measuring a scoliosis is different from traditional Chiropractic Biophysics® line analysis due to excess vertebral rotation, the Risser-Ferguson analysis has been incorporated as PostureRay’s primary method. In addition, we also incorporated the traditional 4-line Cobb method of analysis. While the Cobb method is less valid, as it only measures the end points of the curve, most health care providers including orthopedists, rely on this method by default as a method for gauging the magnitude for a scoliotic deformity. In fact, this method is almost exclusively used in reporting research data. Because of this, we had PostureRay® programmed to digitize both systems of analysis in order to better aid chiropractors in documenting their patient’s scoliosis and communicate findings to other health care providers such as orthopedic spine surgeons.
As with any patient care, scoliosis is no different. You must first educate the patient on the magnitude of their problem. Below in figure 1 is an example of the patient report for the AP thoracic view. On this report, you will find very friendly patient oriented text descriptions of their findings, and again, like in the other x-ray views, there is room for you to make custom notes to your patient.



In figure 2, the Impression report can be seen. In this view, you will see that PostureRay superimposes the actual line drawing method on the x-ray itself. Furthermore, PostureRay® can quantify and qualify the patient regardless if they have one or two curves in their thoracic region.





As chiropractors, we now have the tools to more easily measure, track and create evidence-based treatment plans for patients. Using tools such as PostureRay® saves time and creates unlimited marketing potential with referring medical doctors, particularly opening doors with orthopedic spine surgeons.
If you are interested in learning more about PostureRay® and how it can help you better document and treat your patients, please go to www.postureco.com or email sales@postureco.com.

Reference List
1. Schwab F, Dubey A, Gamez L et al. Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine 2005;30:1082-5.
2. Weinstein SL, Dolan LA, Cheng JC et al. Adolescent idiopathic scoliosis. Lancet 2008;371:1527-37.
3. Wong HK, Hui JH, Rajan U et al. Idiopathic scoliosis in Singapore schoolchildren: a prevalence study 15 years into the screening program. Spine 2005;30:1188-96.

Joseph R. Ferrantelli, D.C. graduated with honors from Florida State University in 1995 with a B.S. in Biological Sciences and earned his Doctor of Chiropractic (D.C.) degree from Life University School of Chiropractic, graduating Magna Cum Laude in March 1999. Dr. Ferrantelli is a distinguished Fellow of Clinical Biomechanics of Posture and a Certified Instructor for CBP® Seminars. Dr. Ferrantelli was named the “CBP® Chiropractor of the Year” by CBP®Seminars in 2002. Additionally, he has co-authored manuscripts published in top journals such as Spine, European Spine Journal, and JMPT. Dr. Ferrantelli is the webmaster for CBP® OnLine, www.idealspine. com and currently is in private practice in New Port Richey, FL.

Dr. Denise Perron has a Bachelors Degree in Biology and received her DC degree from Palmer Chiropractic College in the middle 1980s. She ran a high volume practice in Montreal, Quebec, Canada from 1986 to 2001. Her interest is in posture digitizers, and she has been working in that field since 2001. She is currently a consultant for business organizations and Chiropractors in Canada, USA, and Japan.

Marking x-rays has never been so easy! Introducing PostureRay

Digitize your Plain Films with digital camera!

In this video clip we demonstrate how to obtain quality images that can be used with the PostureRay system.

Digital X-Ray Machine Not Required!

PostureRay - Thank you to all!

Thanks to your feedback, we have been able to continually improve our product and make it the best, most user friendly x-ray digitizer on the market.

Doctors have been waiting for a way to digitize x-rays that keeps with the Science behind chiropractic, but yet operates in a fast and efficient way thereby generating useful reports needed for patient education, record keeping, and third party payers/referrals or attorneys.

PostureRay® has proven to be an incredible time saver in your office. Digitizing your own films with the aid of your staff has never been easier. The PostureRay® system drastically reduces subluxation diagnosis time, improves documentation, and validates the course of care plans for patients – all in a quick and user friendly manner. By using the PostureRay® system, you are marketing your practice when the patient reports go home with them to share with their families. Furthermore, the doctor centered “Impressions Reports” stimulates referrals from other specialists (usually the patient’s general practioner or orthopedic surgeon) when they see how thorough your chiropractic practice is. Many doctors make a habit of placing the Impressions reports into the patient’s x-rays jackets when referring a patient to another doctor. In addition, many doctors have found the system useful in the personal injury arena, helping their patient’s attorney objectively identify ligamentous injuries thereby building a stronger case for the patient.

PostureRay® supports DICOM

Our Doctors are confirming to us that the system is working well and it is making a difference in their practice by saving them time and producing scientifically based reports that are leading edge technology.

We remind all our doctors that the PostureRay® can also be used with both Digital X-rays and with traditional x-rays (simply by taking a photo of the x-ray film on the view box). At the popular request of our digital x-ray distributors and their clients, this latest iteration of PostureRay® not only is able to incorporate DICOM images, but also interfaces with most PACS systems, allowing for even friendlier importing of images and data from digital systems.

PostureRay® incorporates new assessments.

While we provide the most comprehensive x-ray digitizer today, we continually strive to improve our system in order to serve our profession. We have recently added a more thorough ligamentous laxity assessment on the upper cervical spine that Dr. Harrison teaches in CBP® Seminars. With these new evidenced based measurements, PostureRay® is the first software package available to the clinician to digitize and assess the upper cervical spine in this much detail, such as utilizing the “Powers Ratio.” We also have added support for digitizing APOM in lateral bending positions to better assess subfailure of the alar and accessory ligaments.

We updated the AP thoracic view which now incorporates not only an assessment using the CBP® Modified Risser-Ferguson Method, but also the traditional Risser-Ferguson and Cobb assessments. This becomes quite helpful for doctors who are assessing scoliotic curves and sharing this information with other health care professionals such as orthopedic surgeons.

We look forward to working with our doctors in continuing to provide the most comprehensive x-ray digitization, documentation, and educational system available. Conact us at www.posture co.com

PostureRay Update: Better science, better patient care, better results!

By Denise Perron, D.C. and Joseph Ferrantelli, D.C.

Our last series of articles have informed the readers on the science, the validity and the efficiency of using the PostureRay® software in your offices to analyze and generate x-ray reports for objective documentation, subluxation assessment, and patient education. This time, we would like to update you on some of the latest features for improving patient care and reducing valuable time assessing films.

UPPER CERVICAL STABILITY ASSESSMENT
Since our last article, we have added more objective findings in the report to aid the clinician in diagnosing upper cervical subluxations on the lateral cervical, flexion and extension views. This becomes increasingly important in post traumatic events as the upper cervical spine, for the most part, is never fully assessed for spinal stability. Doctors commonly use the unreliable “eye ball” method for measuring subluxation. But as any astute clinician understands, if you can not find the problem and establish its relationship to normal, how will you treat it?
Typically, when a patient fails to respond, the doctor panics, and goes back and FINALLY measures for subluxations -which should have been performed initially. Why do many chiropractors simply skip such a crucial step in patient care? Simply TIME! Doctors usually will avoid anything that is too time consuming! Let's face it, time is money, doctors know that treating patients is where the profitability for the office is. The more patients you can treat, with outstanding service, the more satisfied patients you have, the more they will refer more patients to the office. Unfortunately, if the wrong treatment is rendered, it is reflected by a patient's unresponsiveness to treatment, leading to discontinuation of care. Consequently, patient retention goes down, and they leave the office without resolution to their problems (subluxated) — negatively affecting the ability of the doctor to sustain a profitable practice. PostureRay® solves this dilemma by allowing the doctor to quickly measure the upper cervical spine radiographs in approximately less than 15-30 seconds! In this short amount of time, measurements such as ADI, Clivus-Dens Interspace, Power's Ratio (Index), Basilar Impression, C0/C1/C2 stability can be assessed objectively. Let us ask you this, when was the last time you calculated C0/C1/C2 stability from flexion to extension let alone Power's Ratio?
With this updated technology, existing PostureRay® users all have given us similar stories — they find themselves going back to those “tough cases” and digitizing them, soon realizing they missed something that would have altered their application of adjustments, treatment, or exercise regiments! Sometimes ignorance is bliss, but more often, ignorance leads to poor patient outcome.
ADDITIONAL PATIENT REPORTING
In addition to the new upper cervical assessment, this latest version of PostureRay® now offers a “Patient Centered Post Report of Findings Report” demonstrating the efficacy of your spinal rehab program. With this new report, a short, concise, and motivating summary of why post xrays are obtained along with large x-ray images and segmental and global changes.
Finally, the Posture-Ray® report is a document that patients understand, that insurance companies appreciate and that Doctors can validate the need for chiropractic care with. Based on radiographic, scientific evidence, the doctors can explain and substantiate their care plans to their patients. The report explains in detail the x-ray analysis as well as demonstrates the results in a table format that is easy for doctors and patients to follow which is to be used in conjunction with the PostureRay® digital view box.
Because you are a serious Chiropractor, concerned about making sure that patients get the best care possible, you must consider the PostureRay® for your office. The time you will save will be better spent serving and helping more patients restore and maintain their health through chiropractic. For more information or examples of the PostureRay® reports, please email PostureCo at sales@postureco.com.

PostureRay® Update Dr. Don Harrison’s Software Legacy — Chiropractors Thank You!

Software developed by technology companies such as PostureCo™ and BioTonix™ have been powered by the inspiration and knowledge of Dr. Don Harrison and his team. His contribution has allowed us to bring you the best in leading edge, scientifically based tools for clinical practice. The first product to emerge under his guidance was the PosturePrint® system. Today almost four years later, the PosturePrint® system continues to stand alone unparalleled in the world of postural assessment for the clinical setting. Dr. Don along with his colleagues, especially Tad Janik, PhD, went on to publish PosturePrint® related research in JMPT, European Spine Journal, and Chiropractic & Osteopathy proving not only its validity, but also its reliability and repeatability, making it the “Gold-Standard” for anyone serious about analyzing and correcting posture.
Following development of PosturePrint®, Dr. Don had several requests from chiropractors in the field for a simple and quick tool for posture assessment to be used outside the office for health talks, health fairs, and other typical spinal screening venues. This led Dr. Don to deliver the “screening” tool which finally became PostureCo’s first product known as PostureScreen®. Although not a scientific clinical tool such as PosturePrint®, it fits well in the suite of products to support doctors in educating the public on posture and its adverse effects on health when spinal screening time is a precious commodity. Again, Dr. Don was at the helm of making this product become a reality.
Next, Dr. Harrison’s real dream finally came to fruition late last year — an advanced, yet simple to use x-ray digitization program known as PostureRay®. This software takes all the CBP® line drawing and analysis (as well as other chiropractic technique and orthopaedic specific analysis) into a digitizing tool that can generate not only patient-centered presentation of findings, but also impression reports (doctor-centered reports) for objective documentation aiding in justification of patient care. Not only is this tool essential for your patient’s understanding of their spinal subluxation, but it proves to be an essential marketing tool for potential patients, attorneys and medical doctors.
This digitizing program allows the doctors to quickly analyze films quantitatively and have all the data in a report form, for patients, insurance companies and for referral/marketing purposes. It is Dr. Don’s vision that all chiropractors will want to treat patients with the best care possible and these tools make the delivery of the care seamless and a painless addition to any chiropractic practice. By using these tools, the doctor can focus once again on the patient’s need and the adjustments, saving the doctor substantial time on painstaking biomechanical subluxation analysis.
At this year’s CBP® annual seminar, it is a historical moment for us all – Dr. Don is officially retiring from CBP® seminars, and passing the torch to his son Dr. Deed Harrison. While Dr. Don will no longer be at most CBP® seminars, he has vowed to keep his advisory role in the development, testing, and related research of PostureCo™ products. This will allow, the doctor, to continue benefiting from time-saving, scientifically-scrutinized software.
Dr. Don, we — along with chiropractors across the world — thank you! May your next years of retirement bring you the relaxation you very much deserve.
For more information or examples of the PostureRay® reports, please email PostureCo at sales@postureco.com.

Joseph R. Ferrantelli, D.C. graduated with honors from Florida State University in 1995 with a B.S. in Biological Sciences and earned his Doctor of Chiropractic (D.C.) degree from Life University School of Chiropractic, graduating Magna Cum Laude in March 1999. Dr. Ferrantelli is a distinguished Fellow of Clinical Biomechanics of Posture and a Certified Instructor for CBP® Seminars. Dr. Ferrantelli was named the “CBP® Chiropractor of the Year” by CBP®Seminars in 2002. Additionally, he has co-authored manuscripts published in top journals such as Spine, European Spine Journal, and JMPT. Dr. Ferrantelli is the webmaster for CBP® OnLine, www.idealspine. com and currently is in private practice in New Port Richey, FL.

Dr. Denise Perron has a Bachelors Degree in Biology and received her DC degree from Palmer Chiropractic College in the middle 1980s. She ran a high volume practice in Montreal, Quebec, Canada from 1986 to 2001. Her interest is in posture digitizers, and she has been working in that field since 2001. She is currently a consultant for business organizations and Chiropractors in Canada, USA, and Japan

Digital X-ray Digitization and Analysis has Finally Arrived

Dr. Joseph Ferrantelli obtained his Bachelors of Science in Biology in 1995 from Florida State University and his D.C. degree from Life University in 1999, and currently maintains a private practice in New Port Richey, FL. He is currently an active board member for CBP® Non-Profit, a Distinguished Fellow of CBP®, and a CBP® Certified Instructor. He has co-authored articles in such journals as JMPT, Spine, and the European Spine Journal. In 1996, Dr. Ferrantelli established the official CBP® website, CBP® OnLine at www.idealspine.com. He may be reached via email at webmaster@idealspine.com.

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I always dreamed for a day that a computerized system would come along and simplify the detailed x-ray analysis that comes with providing first-rate care to patients. In many Chiropractic Techniques, to do a good and thorough job, you must “hand draw” on x-rays and to measure spinal subluxations using a protractor. I use the Harrison Orthogonal Template (OXI).

This x-ray line drawing is not only a tedious task, but also is very time consuming. For most doctors, they must analyze films themselves, which can put doctors behind, taking time away from adjusting patients. This leaves most doctors to resort to simply using only the briefest of lines (like only using the CBP® normal templates for patient education). How do I know? Quite simply, because not only do most of you tell me this at seminars, but I too did this early in my career!

Sometimes, you begin to fall victim of “believing” that you are good enough to treat patients without a thorough segmental analysis. However, if you have treated patients long enough, you soon realize, that many of the patients who failed to “respond” to care may have been because you, as a clinician, failed to recognize the significant yet subtle segmental vertebral hyperextension or hyperflexion buckling (2nd and 3rd harmonics) of the sagittal curves on lateral views. If you didn’t identify the displacement, how likely would you be to correct it?

PostureRay™ to the rescue!

Just like PosturePrint® (available at the Biotonix website) has simplified and reduced clinician time for the objective quantification of postural displacements, PostureRay™ (available at the new PostureCo company) is the analogous system for x-ray displacement analysis. PostureRay™ was developed by PostureCo for Chiropractic Techniques that use x-ray analysis and is a standalone x-ray digitizing system. This system allows you to analyze your plain films using lines of mensuration quickly, easily, and painlessly! Right now it has the ability to peform the Harrison sagittal analysis of absolute and relative rotation nagles, but soon it will provide nasium and Gonstead analyses.

No longer will you have to stay after hours or come in on the weekends to analyze your films. With PostureRay™, you simply have your office staff obtain digital pictures of your films (using an ordinary digital camera), scan your films using an X-Ray film scanner, or even better - invest in a digital x-ray system. Regardless of how you obtain the x-ray digital images, they can be analyzed by PostureRay™ (see Figure 1).

Give your patients the evidence for them to want a care plan

Often chiropractors are reluctant on giving care plans or explanations as to why it will take time to alleviate symptoms, correct the underlying problem, and maintain wellness. As you decide about giving patients care recommendations, remind yourself as well as them that when conditions are diagnosed, traditionally there have been validated courses of care for that condition. The same is true with musculoskeletal disorders and now you can provide them evidence as to what the research demonstrates in cases such as theirs. This allows them to make a more informed decision about engaging in your/their care. The fact of the matter is patients need to understand why they need corrective care. We need to provide them with legitimacy about their condition along with information on how we can help them. The PostureRay™ report is your tool to pass this crucial information on to them. This report synthesizes the information in a simple to understand X-ray ROF personalized for the patients (see Figure 2) and is a take home piece that everyone can understand. Using other reporting options, PostureRay(tm) can be used for insurance reporting, summarizing the patient’s problems and detailing their x-ray findings. This provides them with the information they need to initiate care and continue their care based upon your initial recommendations.

The Best Marketing - Stimulate Internal Patient Referrals

By using PostureRay™, your office will benefit from not only a clinical standpoint - but a practice management standpoint as well. Your patients will get a detailed ROF on their x-ray findings, to go along with their PosturePrint® ROF. Using these to custom patient reports, your patient will be able to go home and show their family and friends their structural problem(s) in a clear and concise manner.

Does this work? Absolutely! Ask Dr. Don Harrison how he built his practice in the 80’s and 90’s and he will tell you the same thing he told me when I opened my doors, “Give your patient’s customized ROF booklet, then get them to your spinal care class.” Dr. Don knew that the decisions for a patient to stick with their care is heavily influenced by their spouse’s perception of your office and treatment. Knowing that many patients fail to bring their significant other to the ROF, the spouse does not get a clear representation of the severity of their loved one’s structural problems. This inadvertently will hurt your patient’s compliance to care thus leading to uncorrected structural problems.

Consequently, when Dr. Deed Harrison began in practice, he continued the “Harrison Tradition” in giving his patients a detailed ROF packet. Early on, Dr. Deed and myself worked on developing a simple word document that we used to manually insert digital images of our patient’s x-rays. This packet also included information on the patient’s postural findings, and exercises that they would eventually begin for corrective care. Eventually this “take home” customized ROF included the PosturePrint® report as well. However, the only problem with this system is we still had to mark and analyze the films by hand, then take digital pictures, then go through the time consuming task of formatting a digital image to fit inside a word document, then manually type in all of the x-ray findings. While very effective in growing our practice and stimulating referrals, when your staff gets busy or distracted by other tasks, they run out of time to deliver these high impact “patient centered” report packets. PostureRay™ solves this problem and has encompassed the ideas of what Drs. Harrison, Dr. Perron, and I have done in our own practices, with the one major advance — it takes minimal time and is all digital!

So what can PostureRay do that the “other” systems can not?

1. Compares your patient’s spine to normal from digital x-ray images of AP and lateral cervical, thoracic, and lumbar films, AP nasiums, AP or PA Ferguson sacral base views (obtaining true anatomical leg length inequality), lateral fullspine and flexion/extension stress views
2. PostureRay™ allows a patient’s x-rays to be available in a simple and easy to use patient database.
3. If you have the additional PostureRay™ networking module, PostureRay™ allows you to call up and do a digital ROF on demand from any workstation in your office.
4. PostureRay™ compares their subluxations at each level to normal and the percentage loss or gain from normal calculated automatically.
5. PostureRay™ superimposes normal lines (using any color) and highlights George’s line (patient’s spinal position) on their digital x-rays. In addition, you can export these images to 3rd party practice management software. Furthermore, this is the ONLY system which can legally and correctly apply and overlay the Harrison spinal model on digital images. Moreover, this system will also incorporate the newer research affecting the lumbar normal model values based on the patient’s own pelvic and sacral morphology.
6. PostureRay™ measures all segmental relative rotational angles and the global absolute rotational angles in degrees along with all translational distances in millimeters. Additionally, PostureRay™ measures segmental instabilities such as spondylolithesis and retrolithesis.
7. PostureRay™ compares patients pre-post care films with percentage improvement at each level of their spine.
8. PostureRay™ allows you to create an injury report showing the areas which worsened with a personal injury or motor vehicle crash from the patient’s pre-post injury films.
9. PostureRay™ objectively measures spinal displacements for impairment ratings based on segmental instabilities using the AMA guides of whole body impairment
10. PostureRay™ will not only print a clear and concise patient centered ROF, but it will also print an insurance based ROF and an injury report for the medical-legal personal injury patients.
11. Using the additional PostureRay™ Expanded Report Module™, you can burn the reports and images to a customized autoplay Report of Findings CD, that a patient can simply play on any computer
12. Using the PostureRay™ IdealTraction™ Module (available next year) you will be able to link your patient’s spine to the most appropriate traction setup.
13. Using the PostureRay™ DMX Module (available next year) you will be able to import images from Digital Motion X-Rays directly from the DVD and analyze them accordingly.
14. So with that being said, the question soon becomes, “How long can your practice survive without PostureRay™?”

For more information on PostureRay™ contact PostureCo, Inc. toll-free at 888-231-2393 or visit www.postureco.com