A Landmark Victory: CBCT Enters Chiropractic Scope in North Carolina
Originally published: 2025-08-17
In a significant advancement for chiropractic care, the North Carolina Board of Chiropractic Examiners (NCBOCE) has officially included Cone Beam Computed Tomography (CBCT) within the scope of practice for licensed chiropractors. Adopted on July 25, 2025, this position statement recognizes CBCT as a specialized form of radiology, aligning it with the foundational training and statutory authority of chiropractors in the state.
This milestone not only enhances diagnostic precision for conditions like vertebral subluxation, spinal instability and craniocervical dysfunction but also signals potential shifts in chiropractic practices nationwide.
The Spark: Identifying the Gap in 2017
The push for CBCT recognition began in 2017 when Dr. Cameron Bearder, a dedicated North Carolina chiropractor, identified that this advanced imaging technology was not explicitly acknowledged in the state's chiropractic legislation. CBCT, which uses a cone-shaped X-ray beam to produce detailed 3D images with lower radiation doses than traditional CT scans, had already shown promise in visualizing the craniocervical junction and cervical spine, areas critical to upper cervical chiropractic care.
Despite its potential to improve patient outcomes by providing adjunctive visualization beyond standard radiography, CBCT's absence from the scope created barriers for practitioners seeking to integrate it safely and effectively.
Setbacks and Academic Momentum: 2020 Onward
Initial outreach in 2020 from Steve O’Neill of Planmed and Dr. Tyler Evans met resistance, with the NC Board declining to consider CBCT at the time. However, the tide began to turn as the technology gained traction in chiropractic education. Sherman College of Chiropractic in South Carolina became the first chiropractic program to install a CBCT unit in early 2020, marking a pivotal step in integrating this tool into training and clinical settings.
Northwestern Health Sciences University in Minnesota and Life West Chiropractic College in California followed suit, with Life West's installation occurring in 2023. These developments underscored CBCT's educational value, equipping future chiropractors with skills for precise imaging of hard tissue structures.
"CBCT offers an equivalent patient radiation dose of 5 to 74 times that of a panoramic X-ray or 3 to 48 days of background radiation."— From a review on CBCT applications in dentistry, highlighting its safety profile relevant to chiropractic use.
Groundbreaking Research: Building the Evidence Base
Key peer-reviewed publications bolstered the case for CBCT. In 2022, authors G. DeNunzio, T. Evans, M.E. Beebe, J. Browning, and J. Koivisto, published a literature review in Dose-Response examining craniocervical junction visualization and radiation dose considerations for upper cervical chiropractic applications. The study emphasized CBCT's role in reducing patient exposure compared to conventional methods while enhancing diagnostic accuracy.
Building on this, Dr. Jeff Scholten, Arif Kos, Dr. Matthew Richardson (DACBR), and K. Campion released a 2023 paper in the Journal of Clinical Chiropractic titled "Cone Beam Computed Tomography: Technology Overview, Dose, and Utility Considerations for Chiropractors and Regulatory Bodies." This work detailed CBCT's technological advantages, clinical utility, and safety protocols, providing regulatory bodies with evidence-informed guidelines.
These papers were instrumental in demonstrating CBCT's alignment with chiropractic principles of evidence-based, non-invasive care.
Renewed Advocacy: Collaboration and Presentation in 2025
By early 2025, momentum surged when Dr. Bearder presented on CBCT analysis through Dr. James Demetrious’ postgraduate continuing education program, sparking interest among North Carolina doctors. A collaborative team including Dr. Bearder, Dr. Demetrious, Dr. Evans, and Dr. Scholten, formally re-approached the NCBOCE.
“We are deeply grateful to Dr. Arnone, Dr. Bearder, Dr. Demetrious, and Steve O’Neill for their persistent efforts. This win is not only a victory for chiropractors in North Carolina, but a signal to other states that CBCT has a valuable role in advancing safe, evidence-informed chiropractic care.”— Dr. Tyler Evans
Official Approval: A New Era for Diagnostics
On July 25, 2025, the NCBOCE adopted its position statement:
"Radiology is a part of the training of chiropractic physicians and is within the scope of chiropractic practice (NC GS 90-153.3(b)). CBCT is a specialized form of radiology. After a careful review of the indications, uses, research and education provided by the chiropractic schools, the board approved use of cone beam computed tomography (CBCT) for chiropractors in North Carolina who have adequate training in its indications, techniques, interpretation, and safe use."
This approval, listed among the board's position statements, requires practitioners to adhere to state radiation protection rules and ensure proper training.
Future Implications: Enhancing Patient Care Nationwide
Chiropractors hailed this as a forward-thinking decision, potentially inspiring other states to follow suit.
For patients, CBCT means more accurate assessments without unnecessary referrals, fostering holistic, efficient care. As chiropractic evolves, this inclusion highlights the profession's commitment to innovation grounded in safety and evidence.
