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Table 4 Inductive themes with representative examples of responses

From: Historical influence on the practice of chiropractic radiology: part II - thematic analysis on the opinions of diplomates of the American Chiropractic College of Radiology about the future

Category of theme 2nd degree theme 1st degree theme Qty Examples
Inductive themes Strengths Collegial respect 2 - 20% of my full time practice is requests from health practitioners other than chiropractors. So they respect our competency and education.
- I am treated as an equal from the medical radiologists.
   More detail in reports 1 - More detailed report with findings sometimes overlooked by our MD radiologists brethren.
   Improved chiropractic education 2 - I believe that the chiropractic profession in general improves over time as education has improved.
- The demand for chiropractic radiologists will grow as the chiropractic clinicians skill set grows with the management of more challenging clinical problems.
   Perseverance 1 - We make our opportunities by working our rear-end off, ethically and without compromise…and with a whole lot of patience & humility.
   Teaching 4 - Most will likely need a full time work whether in a clinical or academic setting.
- Training radiologists to teach at the institutions.
  Weaknesses Image quality 2 - It seems most chiro offices that have x-ray suites produce garbage film quality.
- [Institutions] should concentrate on [teaching] good film quality.
   Undervaluation of DACBRs 8 - The value of [DACBRs] seems to be ignored by 90% of practicing Chiropractors.
- I worry that we are not valued enough by the chiropractic profession.
   Vitalism 1 - Those practitioners who operate in a more vitalistic model are not concerned with pathology and do not believe expert interpretation worthwhile.
  Opportunities Accreditation 6 - Some residencies will be phased out due to the cost of meeting stringent external accreditation expectations.
- We will have to get some form of external accreditation for our training and certification process or ACR will push us out of the sandbox.
   Advanced imaging 9 - More MRI: the chiropractic radiologist is going to have to be credentialed mainstream for reimbursement purposes.
Chiropractic radiology training/certification for MRI reading lacks structure, lacks a credentialling process, etc.
- We will need to become more capable of accessing advanced imaging facility referrals.
   Teleradiology 4 - Teleradiology issues will need to be ironed out for our profession as private practitioners accessing digital equipment will make image transference easier and more real time.
- Chiropractic “radiology” will survive, but will move towards 100% digital environments and probably online/distant/international interpretation services.
   DACBRs must focus on chiropractors 10 - New DACBRs should be taught to have more of a service attitude toward treating chiropractors.
- Contemplation of CMT [chiropractic manipulative therapy] can be an indication for radiographs.
- I think we are remiss if we expect chiropractors to apply medical guidelines for imaging indications.
- It would appear to me that there are many academic leaders who are almost totally devaluing and discrediting the need for chiropractors to order or take imaging studies. These efforts must be vigorously opposed since it is this privilege that mostly sets our system of patient care apart from all others (pists and paths) [sic].
   Integration 12 - Important for us to partner with outpatient imaging centers, or even hospitals.
- Hopefully towards the trend of being further and more widely incorporated into allopathic medical imaging centers.
   Evidence-based practice 7 - I would like to see [fluoroscopy] gone - it does not offer medical benefit.
- If the profession as a whole can move towards working in an evidence-based manner, then there may be a future for chiropractic radiologists.
- We have to be aware of and contribute to the current literature with respect to the significance of imaging findings.
   Future depends on future of chiropractic 7 - As the profession goes, so do we
- As a radiologist who reads films for chiropractic practices… continuing growth.
- Specialized fields (like chiropractic radiologists) depend on the health of the referring body of chiropractors.
   Incorporate interventional procedures 1 - Imaging groups… are less likely to hire chiropractic radiologists who can’t perform basic interventional procedures.
   Political representation needed for DACBRs 1 - We need a strong independent DACBR professional organization to represent us a distinct speciality.
  Threats Extinction 5 - It will eventually die out, not in my or your lifetime.
- I would not be surprised to see the field completely disappear in 20 to 30 years.
   Medical prejudice 3 - Continual efforts by organized medicine to exclude DACBRs from film reading opportunities will also make it more difficult to remain viable.
- MD radiologists are pressured by their colleagues to not allow DC radiologists to practice with them.
   Less radiography 8 - As fewer chiropractors take x-rays, those patients who DO need x-rays will be sent to imaging centers who have their own medical radiologists.
- As evidence based medicine and collaborative care continues to gain popularity, how long will it be before chiros in North America also lose their right to use (abuse) ionizing radiation as a diagnostic tool?
   Reduced reimbursement 14 - Most chiropractors seem less inclined to pay for radiological interpretation services, and those who are inclined, many times cannot afford the expense in a managed care model of private practice.
- Majority of my reads are cash basis because insurance reimbursements are so poor.
  Not applicable Answer too complex to give on survey 3 - Too long to explain.
- This question is too broad. Respectfully, I don’t have time to tell you everything I think about this topic.