{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T11:07:41Z","timestamp":1792148861093,"version":"4.4.0"},"reference-count":120,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2019,10,1]],"date-time":"2019-10-01T00:00:00Z","timestamp":1569888000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"CBP NonProfit, Inc."}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Dose-Response"],"published-print":{"date-parts":[[2019,10,1]]},"abstract":"<jats:p>There is substantial evidence for normal relationships between spine and postural parameters, as measured from radiographs of standing patients. Sagittal balance, cervical lordosis, thoracic kyphosis, lumbar lordosis, pelvic tilt, and the more complex understanding of the interrelations between these essential components of normal stance have evolved to where there are known, established thresholds for normalcy. These spinal parameters are reliably measured from X-ray images and serve as goals of care in the treatment of spine and postural disorders. Initial and follow-up spinal imaging by X-ray is thus crucial for the practice of contemporary and evidence-based structural rehabilitation. Recent studies have demonstrated that improvement in the spine and posture by nonsurgical methods offers superior long-term patient outcomes versus conventional methods that only temporarily treat pain\/dysfunction. Low-dose radiation from repeated X-ray imaging in treating subluxated patients is substantially below the known threshold for harm and is within background radiation exposures. Since alternative imaging methods are not clinically practical at this time, plain radiography remains the standard for spinal imaging. It is safe when used in a repeated fashion for quantifying pre\u2013post spine and postural subluxation and deformity patterns in the practice of structural correction methods by chiropractic and other manual medicine practices.<\/jats:p>","DOI":"10.1177\/1559325819891043","type":"journal-article","created":{"date-parts":[[2019,12,6]],"date-time":"2019-12-06T05:46:26Z","timestamp":1575611186000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":21,"title":["Repeat Radiography in Monitoring Structural Changes in the Treatment of Spinal Disorders in Chiropractic and Manual Medicine Practice: Evidence and Safety"],"prefix":"10.1177","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3117-7330","authenticated-orcid":false,"given":"Paul A.","family":"Oakley","sequence":"first","affiliation":[{"name":"Private Practice, Newmarket, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niousha Navid","family":"Ehsani","sequence":"additional","affiliation":[{"name":"Private Practice, Newmarket, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deed E.","family":"Harrison","sequence":"additional","affiliation":[{"name":"CBP NonProfit, Inc, Eagle, ID, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2019,12,6]]},"reference":[{"key":"bibr1-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1115\/1.4043650"},{"key":"bibr2-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-018-5462-y"},{"key":"bibr3-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-011-1940-1"},{"key":"bibr4-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-011-1939-7"},{"key":"bibr5-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1007\/s005860000224"},{"key":"bibr6-1559325819891043","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.D.02043"},{"key":"bibr7-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1227\/01.neu.0000462077.50830.1a"},{"key":"bibr8-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-017-5367-1"},{"key":"bibr9-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-011-1928-x"},{"key":"bibr10-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-006-0294-6"},{"key":"bibr11-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000155560.92580.90"},{"key":"bibr12-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1067\/mmt.2000.110941"},{"key":"bibr13-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-4754(99)70053-9"},{"key":"bibr14-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000002346"},{"key":"bibr15-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-016-4411-x"},{"key":"bibr16-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-016-4702-2"},{"key":"bibr17-1559325819891043","doi-asserted-by":"publisher","DOI":"10.31616\/asj.2018.0097"},{"key":"bibr18-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0000000000001193"},{"key":"bibr19-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000000347"},{"key":"bibr20-1559325819891043","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.M.01459"},{"key":"bibr21-1559325819891043","volume-title":"Clinical Biomechanics of the Spine","author":"White AA","year":"1990"},{"key":"bibr22-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1002\/jor.1100110407"},{"key":"bibr23-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-198909000-00015"},{"key":"bibr24-1559325819891043","doi-asserted-by":"publisher","DOI":"10.3171\/spi.2007.6.2.104"},{"key":"bibr25-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-011-1930-3"},{"key":"bibr26-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-198805000-00001"},{"key":"bibr27-1559325819891043","volume-title":"Evidence-Based Prevention and Rehabilitation","author":"McGill SM","year":"2002"},{"key":"bibr28-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199904150-00006"},{"key":"bibr29-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199711010-00005"},{"key":"bibr30-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2016.01.006"},{"issue":"2","key":"bibr31-1559325819891043","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/S0030-5898(20)30318-7","volume":"19","author":"La Grone MO","year":"1988","journal-title":"Orthop Clin North Am"},{"key":"bibr32-1559325819891043","doi-asserted-by":"publisher","DOI":"10.3171\/2013.4.SPINE12838"},{"key":"bibr33-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3182a7f449"},{"key":"bibr34-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1097\/BSD.0000000000000352"},{"issue":"4","key":"bibr35-1559325819891043","first-page":"270","volume":"49","author":"Oakley PA","year":"2005","journal-title":"J Can Chiropr Assoc"},{"issue":"1","key":"bibr36-1559325819891043","first-page":"111","volume":"50","author":"Bettany-Saltikov J","year":"2014","journal-title":"Eur J Phys Rehabil Med"},{"key":"bibr37-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1097\/01.BRS.0000048648.73805.98"},{"key":"bibr38-1559325819891043","first-page":"59","volume":"1","author":"Oakley PA","year":"2018","journal-title":"J Contemporary Chiropr"},{"key":"bibr39-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.159.11.1215"},{"key":"bibr40-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-003-1412-5"},{"key":"bibr41-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2004.52458.x"},{"key":"bibr42-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/12.3.225"},{"issue":"4","key":"bibr43-1559325819891043","first-page":"231","volume":"30","author":"Anderson F","year":"1976","journal-title":"Br J Prev Soc Med"},{"key":"bibr44-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1097\/00002060-199308000-00009"},{"key":"bibr45-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200008150-00009"},{"key":"bibr46-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1667\/RR2022.1"},{"key":"bibr47-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2014.10.006"},{"key":"bibr48-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2017.04.034"},{"key":"bibr49-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-017-1534-0"},{"key":"bibr50-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1053\/crad.2001.0679"},{"key":"bibr51-1559325819891043","first-page":"151","volume":"6","author":"Biedermann H","year":"1992","journal-title":"J Manual Med"},{"key":"bibr52-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2004.10.050"},{"key":"bibr53-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-004-0734-0"},{"key":"bibr54-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2009.09.016"},{"issue":"2","key":"bibr55-1559325819891043","first-page":"3","volume":"74","author":"Frost HM","year":"2004","journal-title":"Angle Orthod"},{"issue":"3","key":"bibr56-1559325819891043","first-page":"175","volume":"64","author":"Frost HM","year":"1994","journal-title":"Angle Orthod"},{"key":"bibr57-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-017-1696-9"},{"key":"bibr58-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1016\/S0268-0033(01)00006-7"},{"key":"bibr59-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1067\/mmt.2002.126128"},{"key":"bibr60-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-016-1193-6"},{"key":"bibr61-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1007\/s005860000243"},{"key":"bibr62-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-010-1614-z"},{"key":"bibr63-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2013.09.043"},{"key":"bibr64-1559325819891043","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-197456080-00018"},{"key":"bibr65-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.65B5.6643566"},{"key":"bibr66-1559325819891043","doi-asserted-by":"publisher","DOI":"10.3233\/BMR-130452"},{"key":"bibr67-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-014-3241-y"},{"key":"bibr68-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0168746"},{"key":"bibr69-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-6196(12)61372-X"},{"key":"bibr70-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-017-4109-x"},{"key":"bibr71-1559325819891043","first-page":"846","volume":"97","author":"Moustafa IM","year":"2011","journal-title":"Phys Ther"},{"issue":"2","key":"bibr72-1559325819891043","first-page":"29","volume":"18","author":"Moustafa IM","year":"2013","journal-title":"Bull Fac Phys Ther Cairo Univ"},{"key":"bibr73-1559325819891043","volume-title":"Proceedings of the 13th World Federation of Chiropractic Biennial Congress\/ECU Convention","author":"Moustafa IM","year":"2015"},{"key":"bibr74-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2016.07.022"},{"key":"bibr75-1559325819891043","doi-asserted-by":"publisher","DOI":"10.23736\/S1973-9087.16.04179-4"},{"key":"bibr76-1559325819891043","doi-asserted-by":"publisher","DOI":"10.3233\/BMR-150464"},{"key":"bibr77-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-018-2317-y"},{"key":"bibr78-1559325819891043","first-page":"142","volume-title":"Proceedings of the 15th World Federation of Chiropractic Biennial Congress\/78th European Chiropractor\u2019s Union Convention","author":"Moustafa IM"},{"key":"bibr79-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmpt.2012.04.021"},{"key":"bibr80-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1177\/0269215512446093"},{"key":"bibr81-1559325819891043","doi-asserted-by":"publisher","DOI":"10.3233\/BMR-130372"},{"key":"bibr82-1559325819891043","first-page":"1","author":"Pellis\u00e9 F","year":"2019","journal-title":"J Neurosurg Spine"},{"key":"bibr83-1559325819891043","doi-asserted-by":"publisher","DOI":"10.2967\/jnumed.117.189928"},{"key":"bibr84-1559325819891043","doi-asserted-by":"publisher","DOI":"10.2967\/jnumed.116.180182"},{"key":"bibr85-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1007\/s13752-016-0244-4"},{"key":"bibr86-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1002\/mp.12012"},{"key":"bibr87-1559325819891043","doi-asserted-by":"publisher","DOI":"10.2967\/jnumed.117.195263"},{"key":"bibr88-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1177\/1559325818781437"},{"key":"bibr89-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1177\/1559325818781445"},{"key":"bibr90-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1667\/RR2629.1"},{"key":"bibr91-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1007\/s00247-016-3697-5"},{"key":"bibr92-1559325819891043","unstructured":"Doss M. Should the ALARA Concept and the Image Gently campaign be terminated? Paper Presented at: the International Pediatric Radiology, Chicago, IL. May 17, 2016. https:\/\/www.slideshare.net\/MohanDoss6\/should-the-alara-concept-and-the-image-gently-campaign-be-terminated. Accessed June 21, 2019."},{"key":"bibr93-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1097\/HP.0000000000000381"},{"key":"bibr94-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1177\/1559325818811521"},{"key":"bibr95-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM194609192351201"},{"key":"bibr96-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1667\/RR14080.1"},{"key":"bibr97-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1177\/0960327112467046"},{"key":"bibr98-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1177\/0960327113493303"},{"key":"bibr99-1559325819891043","doi-asserted-by":"publisher","DOI":"10.2203\/dose-response.12-016.Calabrese"},{"key":"bibr100-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1177\/1559325819871757"},{"key":"bibr101-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1177\/1559325817704760"},{"issue":"4","key":"bibr102-1559325819891043","first-page":"555","volume":"86","author":"Calabrese EJ","year":"2013","journal-title":"Yale J Biol Med"},{"key":"bibr103-1559325819891043","doi-asserted-by":"publisher","DOI":"10.2203\/dose-response.13-004.Calabrese"},{"key":"bibr104-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1007\/s00204-014-1295-6"},{"key":"bibr105-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1177\/0960327119846925"},{"key":"bibr106-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1177\/1559325817697531"},{"key":"bibr107-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1177\/1559325818784719"},{"key":"bibr108-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1177\/1559325819850984"},{"key":"bibr109-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1177\/1559325819853163"},{"key":"bibr110-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1177\/1559325818756461"},{"key":"bibr111-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198911093211902"},{"issue":"4","key":"bibr112-1559325819891043","first-page":"108","volume":"8","author":"Cuttler JM","year":"2003","journal-title":"J Physicians Surg"},{"key":"bibr113-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1097\/HP.0b013e31820a1b35"},{"key":"bibr114-1559325819891043","doi-asserted-by":"publisher","DOI":"10.2203\/dose-response.07-014.Mitchel"},{"key":"bibr115-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1191\/0960327103ht365oa"},{"key":"bibr116-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1007\/174_2012_686"},{"key":"bibr117-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1097\/HP.0000000000000833"},{"key":"bibr118-1559325819891043","doi-asserted-by":"publisher","DOI":"10.2203\/dose-response.08-023.Hoffmann"},{"key":"bibr119-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1177\/1559325819852810"},{"key":"bibr120-1559325819891043","doi-asserted-by":"publisher","DOI":"10.1177\/1559325818820973"}],"container-title":["Dose-Response"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1559325819891043","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1559325819891043","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1559325819891043","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T18:02:01Z","timestamp":1777399321000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1559325819891043"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,1]]},"references-count":120,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2019,10,1]]}},"alternative-id":["10.1177\/1559325819891043"],"URL":"https:\/\/doi.org\/10.1177\/1559325819891043","relation":{},"ISSN":["1559-3258","1559-3258"],"issn-type":[{"value":"1559-3258","type":"print"},{"value":"1559-3258","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10,1]]},"article-number":"1559325819891043"}}