Can Physical Therapists Order Imaging? Discover the Truth Here!

Physical therapists help people who experience pain, muscle weakness or loss of mobility due to an injury or chronic illness. They use various techniques and exercises to alleviate these issues, allowing patients to recover physically and mentally.

Sometimes physical therapists may require more detailed information about their patient’s condition than can be determined from a basic physical evaluation. In such cases, imaging tests like x-rays, MRIs or CT scans can provide crucial insights into potential underlying problems.

“The ability to order diagnostic imaging for patients is essential in assessing, diagnosing, and managing their musculoskeletal conditions,” says Tracy L. Bury DC, DACBSP, director of clinical services at Advanced Medical Integration

But can physical therapists actually order imaging themselves? There’s a widespread belief that only physicians have the authority to do so. Still, as healthcare delivery continues to evolve, it’s important to examine whether physical therapists now have the power to take on this responsibility?

If you’re curious (or concerned) about the scope of practice of physical therapy and want to learn more about how they work to diagnose and treat injuries, keep reading!

What is Imaging in Physical Therapy?

Definition of Imaging in Physical Therapy

Imaging in physical therapy refers to the use of various diagnostic imaging techniques such as x-rays, magnetic resonance imaging (MRI), computed tomography (CT) scans, and ultrasounds to diagnose a patient’s musculoskeletal condition. These technologies allow healthcare providers to see underlying structures that may not be visible during a regular physical examination.

The American Physical Therapy Association (APTA) defines diagnostic imaging as “the process of using high-tech equipment to make images or pictures of your body’s internal structures and systems.”

Importance of Imaging in Physical Therapy

Imaging plays a crucial role in physical therapy as it helps physical therapists establish an accurate diagnosis of patients’ musculoskeletal conditions. Once these diagnoses have been made, physical therapists can then create individualized treatment plans that are specific to the patient’s needs, ensuring better outcomes for patients.

Imaging can also help identify issues in a patient’s skeletal structure or joints that could potentially worsen without proper care, making early detection and intervention essential.

A study published in The Journal of Orthopaedic and Sports Physical Therapy reinforces the benefits of imaging, stating, “accurate clinical differential diagnosis based on history and physical findings alone is difficult and often inaccurate, highlighting the importance of appropriate imaging.”

In addition to aiding with the diagnosis and treatment planning processes, imaging can provide reassurance to patients who need confirmation that their symptoms are related to musculoskeletal conditions and not other sources such as malignancy.

“Diagnostic imaging provides valuable information regarding musculoskeletal abnormalities, which in turn enhances therapeutic decision-making.” -Journal of Manipulative and Physiological Therapeutics

While imaging does hold immense value in diagnosing musculoskeletal conditions, not all patients require imaging. Physical therapists are trained to use a range of diagnostic and physical assessment tools during evaluations before deciding on the need for imaging tests.

The APTA further emphasizes that “Physical therapists choose and provide interventions based on the appropriateness of those interventions as they relate to a patient’s particular condition and based on their own credentials—specifically education, experience, knowledge, and skills.”

Diagnostic imaging is an important tool in the physical therapy profession, providing healthcare providers with valuable information regarding musculoskeletal abnormalities that may be difficult to identify via regular examination alone. However, its use should be limited to cases where it contributes significantly to the diagnosis process.

What Types of Imaging Can Physical Therapists Order?

X-ray Imaging

X-ray imaging, also known as radiography, is a common type of medical diagnostic test. It uses electromagnetic radiation to create images of the body’s internal structures, including bones and joints. X-rays are often used by physical therapists to diagnose injuries or conditions that affect bone, such as fracture or osteoarthritis.

According to the American Academy of Orthopaedic Surgeons, x-ray imaging can be used to visualize the following areas:

• Chest and lungs
• Bones and joints
• Digestive system
• Excretory system
• Reproductive organs

Physical therapists may order an x-ray if they suspect a patient has a broken bone or joint, needs to evaluate wear and tear on joints due to arthritis or other degenerative diseases, or if other imaging options are not available or necessary.

Magnetic Resonance Imaging (MRI)

MRI uses strong magnetic fields and radio waves to produce detailed images of the inside of the body. This imaging modality does not use ionizing radiation like x-rays do, which makes it safer for patients. It is often used to look at soft tissues, such as muscles, ligaments, tendons, and organs like the brain.

According to RadiologyInfo.org, MRIs are particularly useful in diagnosing issues related to the central nervous system, musculoskeletal system, and vascular system. MRI is often ordered by physical therapists when there is suspicion of damage to soft tissue. Common diagnoses include herniated discs, rotator cuff tears, and ligament sprains.

MRI can be expensive, and not all facilities or physical therapy clinics may have access to this technology. In some cases, the patient may need a referral from a primary care physician before being able to receive an MRI.

Computed Tomography (CT) Scan

Computed tomography, also known as CT scan, is another imaging modality that uses x-ray technology to create detailed images of the inside of the body. Unlike traditional x-rays, which take one image at a time, CT scans use a series of x-ray images to create cross-sectional views of the body.

According to the John Hopkins Medicine website, physical therapists may order a CT scan for patients when they suspect bone fractures, tumors, internal bleeding, or other conditions that cannot be easily diagnosed through x-ray or MRI. CT scans are often used in emergency situations due to their speed and ability to quickly diagnose potentially life-threatening injuries.

Like MRIs, CT scans can be expensive, and not all facilities or clinics may offer them. The amount of radiation exposure to the patient during a CT scan is higher than with traditional x-rays or MRI, so providers must carefully weigh the risks versus benefits of performing these tests for each individual case.

“While uncommon, evaluating soft tissue damage in a joint such as hip labrum tears and ligamentous knee injuries will likely demand further imaging to better assess extent of injury.”

Physical therapists may order various types of imaging modalities as part of the diagnosis or treatment plan for their patients. X-rays, MRIs, and CT scans are commonly used by PTs to help determine the cause of pain, evaluate the severity of injuries, and identify underlying conditions that may be impacting movement function.

What are the Benefits of Imaging in Physical Therapy?

Physical therapy is an essential part of rehabilitation for millions of people. One of the most critical aspects of physical therapy is determining exactly what kind of treatment a patient needs to help them recover from their specific condition or injury fully.

This is where imaging technology plays a vital role. Through imaging, physical therapists can get a detailed look at what’s going on inside a patient’s body without ever having to perform surgery. This not only helps with diagnosis but also contributes to better planning and more successful outcomes for patients. Let’s explore some of the key benefits of imaging in physical therapy below.

Accurate Diagnosis

The first benefit of imaging in physical therapy is that it provides incredibly accurate diagnostic information about a patient’s condition. Simply put, when a physical therapist has all the data they need from imaging studies such as MRI, CT scans, and X-rays, they can make more informed decisions regarding how best to treat the patient.

For example, imagine a patient complaining of chronic back pain – if the physical therapist suspects spinal stenosis (a narrowing of the spinal cord), imaging tests can immediately be ordered to confirm this, preventing unnecessary treatment, which may worsen the patient’s symptoms.

“Imaging has completely revolutionized physical therapy,” says Dr. Markus Melloh, Director of Health Services Research at Balgrist University Hospital Zurich.

Thanks to imaging technology, PTs now have access to much higher-fidelity diagnostic information than ever before. This helps them identify conditions with greater precision, rule out unlikely diagnoses early-on in the evaluation process, and take action more quickly based on reliable data.

Better Treatment Planning

Once a medical professional establishes a correct diagnosis, the next step is creating a treatment plan tailored to the patient’s specific needs. Imaging plays an essential role in this process because it gives physical therapists accurate information about what exactly is happening inside the patient’s body.

For example, suppose you have severe degeneration or osteoarthritis in your hip joint. In that case, imaging can help establish precisely how extensive the damage is and which areas require more focused rehabilitation exercises. Similarly, for patients with ligament damage from an injury, imaging provides insight into the location and extent of the injury, which helps create an appropriate rehabilitation protocol.

The result of better treatment planning through imaging leads to improved outcomes for patients. By being able to design a bespoke rehabilitation program that addresses issues directly, physiotherapy experts can bring their patients back to full health much faster.

Improved Patient Outcomes

Last but not least, imaging results in overall improved patient outcomes in terms of recovery times. While surgery may be necessary in some cases, imaging allows medical professionals to explore non-surgical options first and confirm positive responses early-on in the process.

Further, by using imaging studies before, during, and after treatments, PTs can accurately monitor how well a patient is responding to their rehabilitation protocols and make changes accordingly.

“Imaging lets us see in real-time how well our patients are doing,” says Dr. Timothy Aloysius, Clinical Director at Genesis Physical Therapy.

This means that therapists can catch any undesirable effects of treatment quickly, reducing risk and allowing them to focus on treatments that show positive results.

While imaging technology was once reserved only for surgeons and physicians, its widespread use has had a significant impact on the practice of physical therapy over recent years. Thanks to advances in digital imagery, physiotherapists can now make more-informed, evidence-based decisions than ever before about how best to treat their patients.

By leveraging the benefits of imaging for accurate diagnosis and designing bespoke treatment plans tailored to a patient’s specific needs, PTs today enjoy unprecedented success rates helping people in our community restore movement, relieve pain, and improve their overall quality of life.

Can Physical Therapists Diagnose Based on Imaging Results?

Physical therapists are healthcare professionals who specialize in the evaluation, treatment, and rehabilitation of movement disorders. They work with patients to improve their mobility, alleviate pain, and promote overall wellness.

In some cases, physical therapists may order imaging tests like X-rays, MRIs, and CT scans as part of their assessment process. However, the question remains whether they can diagnose based solely on imaging results.

Scope of Practice for Physical Therapists

The scope of practice for physical therapists varies depending on the state. In general, however, it does not typically include making medical diagnoses based on imaging or other diagnostic tests.

According to the American Physical Therapy Association (APTA), “physical therapists do not diagnose disease, illness, or other conditions.” Instead, they rely on a clinical evaluation that includes patient history, physical examination, and functional assessments.

While an imaging test may provide useful information about a patient’s condition, a physical therapist cannot use this information alone to make a definitive diagnosis. Rather, they must interpret the imaging results within the context of the patient’s symptoms and limitations and integrate this information into a broader treatment plan.

Interpretation of Imaging Results

Although physical therapists are not trained to read imaging studies, they may review these images as part of their patient evaluation process. This allows them to better understand the anatomical structures involved in a patient’s injury or condition and to develop more targeted treatment plans.

When it comes to interpreting imaging results, physical therapists are limited by their lack of training in radiology. While they may be able to identify obvious abnormalities such as bone fractures or joint dislocations, they are unlikely to detect more subtle changes that may indicate serious underlying conditions.

As such, it is important for physical therapists to work in collaboration with other healthcare providers who are trained in medical diagnosis and imaging interpretation. This allows patients to receive a more comprehensive evaluation and accurate diagnoses that guide appropriate treatment plans.

Collaboration with Other Healthcare Providers

In many cases, physical therapists work as part of an interdisciplinary team that includes physicians, nurses, and other healthcare professionals. By collaborating with these specialists, physical therapists can ensure that their patients receive the best possible care across all aspects of their treatment plan.

When ordering or reviewing imaging studies, for example, physical therapists may consult with radiologists or other imaging experts to obtain a more thorough understanding of their patients’ conditions. Similarly, they may work closely with orthopedic surgeons, neurologists, or other physicians to develop treatment plans that address their patients’ unique needs and goals.

This collaborative approach helps to ensure that patients receive care that is tailored to their individual needs, preferences, and health status while minimizing risks associated with misdiagnosis or incomplete treatment plans.

Liability and Risk Management

Finally, it is important for physical therapists to understand the role of imaging in their practice from a liability and risk management perspective. While ordering imaging tests or interpreting imaging results beyond their scope of practice may seem like a quick solution to identifying patient problems, these actions may lead to increased exposure to legal action if something goes wrong during treatment.

Above all, physical therapists should prioritize patient safety and avoid acting outside of their professional boundaries when providing care. When making decisions about diagnostic testing, they should consider factors such as patient history, symptoms, and response to previous treatments to determine what information is most useful in guiding further care.

“The Physical Therapist’s Guide to Imaging Tests” emphasizes that physical therapists should “keep in mind the ethical and legal ramifications associated with interpreting images beyond your scope of practice.”

While physical therapists may order imaging tests as part of their patient evaluation process, they must be careful not to overstep their professional boundaries by making medical diagnoses based solely on these results. By working collaboratively with other healthcare providers and prioritizing patient safety, physical therapists can ensure that patients receive thorough, effective care that is responsive to their unique needs and goals.

What are the Legal and Ethical Considerations of Ordering Imaging?

Informed Consent

As healthcare providers, physical therapists have a responsibility to inform patients about their treatment plans and obtain informed consent. This includes discussing any potential risks associated with imaging studies, such as exposure to radiation or contrast agents.

According to the American Physical Therapy Association’s (APTA) Guide to Professional Conduct, physical therapists should “obtain informed consent from patients/clients before initiating any intervention” (Section 4E). Informed consent is defined by the APTA as “an individual’s voluntary agreement to undergo a particular procedure or course of action after he/she has been given information about the nature, risks, and benefits of that procedure or course of action.”

“Informed consent is an essential component in establishing trust between patient and provider.” -Kathryn Platt, PT, DPT, OCS

Insurance Coverage and Reimbursement

Physical therapy practices must consider insurance coverage and reimbursement when determining whether to order imaging for their patients. Insurance policies may vary in terms of which imaging studies are covered and under what circumstances.

It is important for physical therapists to understand the different types of insurance policies, including private insurance, Medicare, and Medicaid, to ensure appropriate billing practices. The Centers for Medicare & Medicaid Services provides guidance on coding and billing for radiology services, including computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound.

“Physical therapists need to be knowledgeable not only about the clinical indications for imaging but also the health policy context in which decisions about imaging are made.” -Dimitrios Kostopoulos, PT, PhD

Confidentiality and Privacy

Imaging studies often involve the use of sensitive patient information, such as medical histories and personal identifiers. Physical therapists must take measures to protect this information and ensure patient confidentiality and privacy.

The Health Insurance Portability and Accountability Act (HIPAA) outlines specific guidelines for protecting patient privacy and securing electronic health information. Physical therapy practices should establish policies and procedures for maintaining HIPAA compliance.

“Patient confidentiality is not only a legal obligation; it’s also an ethical duty.” -Dawn Gulick, PT, PhD

Professional Standards and Guidelines

Physical therapists must adhere to professional standards and guidelines when ordering imaging studies. The APTA has established guidelines regarding the use of diagnostic imaging in physical therapy practice.

According to the APTA, “physical therapists may order diagnostic imaging after completing appropriate training and providing rationale for its necessity in accordance with state practice acts, facility policies, or payer requirements” (APTA Radiography Position Statement).

“The key to responsible utilization of diagnostic imaging techniques is that the clinician should always ask themselves: Do I really need this test to make a diagnosis?” -Remy Gross, PT, DPT

Physical therapists must consider legal and ethical considerations when making decisions about ordering imaging studies. This includes obtaining informed consent, understanding insurance coverage and reimbursement, protecting patient confidentiality and privacy, and following professional standards and guidelines. By doing so, physical therapists can provide high-quality care while upholding their responsibilities as healthcare providers.

When Should Physical Therapists Consider Ordering Imaging?

Failure to Respond to Conservative Treatment

Physical therapy is often the first line of treatment for musculoskeletal injuries and conditions. However, in some cases, patients may not respond to conservative treatment, such as exercise and manual therapy, and their condition may worsen over time or fail to improve despite continuing rehabilitation efforts.

In these situations, physical therapists may consider ordering imaging studies, such as X-rays, MRIs, or CT scans, to help diagnose the underlying cause of the patient’s symptoms. These tests can provide a more detailed view of the affected area and identify any structural damage or abnormalities that may require further medical intervention.

“Imaging studies are crucial in providing definitive diagnoses where clinical information is insufficient,” says Dr. Michael J. Lee, MD, assistant professor of orthopedic surgery at Mount Sinai Hospital in New York City. “They also allow us to plan for the appropriate management strategies based on accurate anatomical and pathological information.”

Presence of Red Flags

Red flags refer to warning signs and symptoms that indicate a potentially serious underlying condition. In some cases, red flags may be present even if the patient’s initial evaluation and assessment appear to be normal.

Examples of red flags include severe pain that does not respond to treatment, weakness or numbness in one or both limbs, fever or chills, unexplained weight loss, and changes in bowel or bladder function. Additionally, patients who have a history of cancer or other chronic illnesses may also be more likely to experience red flags.

If red flags are present, physical therapists should consider referring the patient to an appropriate specialist and order imaging studies as part of the diagnostic process. This can help ensure that serious conditions are identified and treated early, improving the patient’s overall prognosis and outcome.

“Red flags are signs that physical therapists shouldn’t ignore,” says Dr. Tito Liotta, MD, FAANS, neurosurgeon at AdventHealth Medical Group in Orlando, Florida. “Imaging studies can help us identify underlying causes of these symptoms, such as spinal cord or nerve root compression, tumors, infections, or inflammatory conditions.”

Post-Surgical Rehabilitation

After surgery, patients may require ongoing rehabilitation to help restore function and strength in the affected area. In some cases, imaging studies may be necessary to monitor the healing process and ensure that there are no complications or additional injuries that could impede recovery.

For example, if a patient has undergone joint replacement surgery, X-rays may be taken periodically to assess the position and stability of the implant. Similarly, if a patient has had spine surgery, MRIs may be used to evaluate the extent of fusion and determine whether any hardware is causing irritation or dysfunction.

Physical therapists who work with post-surgical patients should be familiar with the imaging protocols associated with various types of procedures and collaborate closely with the patient’s surgeon to optimize their care plan.

“Postoperative imaging is critical for surgical planning and follow-up after orthopedic procedures,” says Dr. Joseph Ippolito, DO, assistant professor of orthopedics at NYU Langone Health in New York City. “Without proper surveillance, complications such as prosthetic loosening, infection, and fracture can go undetected and lead to suboptimal outcomes.”

Screening for Osteoporosis and Fracture Risk

Osteoporosis is a common condition characterized by weakened bones that are more prone to fractures and other injuries. Physical therapists may encounter patients who are at risk for osteoporosis or have a history of low bone density and fragility fractures.

In these cases, imaging studies such as dual-energy X-ray absorptiometry (DXA) scans may be ordered to assess the patient’s bone mineral density and fracture risk. This can help physical therapists develop appropriate exercise and prevention programs that minimize the risk of falls and injuries.

“Patients with osteoporosis or those at high risk for developing the condition require specialized evaluation and management,” says Dr. John DiPreta, MD, FAANS, neurosurgeon and medical director at Florida Hospital Memorial Medical Center in Daytona Beach, Florida. “Imaging studies play an important role in identifying patients who need closer monitoring and intervention.”

In conclusion, while physical therapy is an effective treatment option for many musculoskeletal conditions, there are situations where additional diagnostic tools such as imaging studies may be necessary. Physical therapists should consider ordering imaging tests if conservative treatments fail, red flags are present, patients require post-surgical follow-up, or screening for osteoporosis and fracture risks is needed. By working closely with other healthcare professionals and utilizing imaging appropriately, physical therapists can help optimize patient outcomes and improve overall quality of care.

Frequently Asked Questions