In France, chiropractors are not allowed to take their own radiographic images. Michelle Wessely, BSc (Chiropractic), DC, DACBR,  the first head of the Department of Radiology at the Institut Franco-European de Chiropratique, shares her experiences and contribution to offering radiology courses to French DCs and students.

Chiropractic has been in existence here in France for just a few years and is in the process of being formally legalized. A huge effort has been made by the members of the French Chiropractic Association (AFC) to continue to develop the profession here in France.

The Institut Franco-Europeen de Chiropratique (IFEC) has undergone some dramatic changes in the past few years. The college was originally placed more in the center of Paris, but due to the increase in class size, the decision was made to move the college to its current site in Ivry-sur-Seine, which is just outside the main center of Paris. The location is ideal for commuting into Paris and is an area that is rapidly expanding.

Equally, the level of education for the students at IFEC has been continuing to evolve, reflecting the demands of the profession, including radiology. The undergraduate course is 6 years in duration, the first 5 full-time years based at IFEC and the last year based in clinical practice.

I arrived at IFEC in September 2002 and was made the head of the Department of Radiology. On arriving, I did not speak one word of French. I must acknowledge the enormous patience and dedication of the students who have supported me throughout my ordeal of trying to learn the language. After 6 months, I decided to teach all the courses in French. However, I am insistent that they try to learn English since so many of the postgraduate seminars are taught in English.

The Department of Radiology was opened unofficially in the spring of 2003 after several years of discussion. I arrived to find that the construction and changes were already taking place thanks to the hard work of the previous teachers. The department is now fully equipped with computers and viewboxes (called negatoscopes), and has revolutionized the way in which radiology can be taught to the chiropractic students in France.

Currently, I am the only member of the department, which gives me a great deal of exciting work. I teach all the undergraduate courses in radiology as well as provide input for several courses, such as orthopedics and rheumatology. In addition to undergraduate teaching, I also consult in the IFEC teaching clinic, reading all the films, including special imaging that patients bring with them. This is a very good opportunity to discuss the cases with the students and determine the relevance of the imaging findings to the patient—an important part of integrating their knowledge with clinical cases.

But why do chiropractic students need to know about radiology if chiropractors in France are unable to take their own images? It is fundamental to the training of chiropractor sto know what conditions may present to them that carry with them certain contra-indications to treatment. It is also important for appropriate referrals to be made and to be able to interpret the imaging study. The procedure in France is rather cumbersome where patients are referred to radiologists via their general physicians, or if privately, directly to the radiologist.

Radiology is now taught in each year, starting in the first year by introducing the students to the concept of why chiropractors need to know about it; discussing the place of imaging including magnetic resonance imaging (MRI); computed tomography, and ultrasound in their future practices; and defining the normal radiographic anatomy of the spine and extremities. Throughout the course from the first to fifth year, the students are taught which imaging technique is the most suitable to recommend for the variety of conditions that present to chiropractors in France.

All the courses are taught using computers, which are appreciated by the students and the chiropractors who attend the radiology courses. In addition to using the computers, I have been involved in the creation of the study area, which consists of view boxes and the teaching files. On arrival here at IFEC, I discovered piles upon piles of uncatalogued images; therefore, a large part of my initial work was to categorize the images and also create an image bank for this fantastic collection. (Donations are always welcome from any part of the world, especially of special imaging.)

The initial important courses on normal anatomy are followed by consecutive trimesters to the fifth year initially withnormal variants and congenital anomalies before launching into the osseous pathologies. Throughout the course, emphasis is placed on the practical application of radiology, and cases from the clinic are presented to illustrate clnical situations. A radiology club is run twice a week, where the students choose the topic to be reviewed or discussed. This ranges from looking at normal radiographs to showing part of my teaching collection. A radiology competition is also run each term, presenting weekly cases to challenge the students. Prizes for the best student at the end of each term have included radiology books.

The fifth year at IFEC is based in the teaching clinic and concentrates on improving clinical skills. During the final year, an intensive radiology review course is given, aimed at extending knowledge of special imaging as well as reviewing fundamental concepts. An opportunity exists also to review the most interesting cases each week with the class, which allows those with patients without imaging studies to learn from those whose imaging studies were warranted.

As I prepare for new students this year, I realize how many changes have been made in the past year. With the evolving world of imaging, it is important to be able to reflect the current imaging modalities in to the undergraduate program, the MRI for example, which is becoming more available in France. In the future, I hope that the enjoyment of radiology will continue here at the college and throughout the profession. CP

Michelle Wessely, BSc (Chiropractic), DC, DACBR, FCC (UK/Radiology), is the departmental head of Radiology at Institut Franco-European de Chiropratique, Paris. She completed her fellowship in musculoskeletal radiology at the Department of Osteoradiology, Veterans Affairs Healthcare Center, San Diego, under Donald Resnick, MD, professor of radiology. Wessely provides a film-reading service for chiropractors and lectures to both chiropractic undergraduates and postgraduates in Europe. She can be reached at: mwessely@ifec.net;   michelle_wessely@yahoo.com.