The definitive radiology textbook by Terry R. Yochum, DC, DACBR, is one of the most important and respected contributions to the profession.

The staff of Rocky Mountain Chiropractic Radiological Center: Terry R. Yochum, DC, DACBR (seated), (back row from left) Lanna Gosage, RT, chief technologist; Connie Jones RT, office manager; Wanda Hidy, administrative secretary. The low employee turnover makes for a successful practice—Gosage has been with Yochum for 5 years, Hidy, 8 years, and Jones for 21 years.

Every so often, a chiropractor takes an x-ray that bewilders more than it enlightens. When that happens, he can either spin his wheels and lose precious clinical time attempting to puzzle it out for himself, or he can simply pass the image over to Terry R. Yochum, DC, DACBR, and rest assured the elusive—but correct—interpretation will be reached in surprisingly short order.

Yochum operates what some consider to be the nation’s foremost radiology-specialized chiropractic consult practice, Denver-based Rocky Mountain Chiropractic Radiological Center. Yochum is so on the mark with his interpretations of images that even medical doctors do not hesitate to turn to him for an opinion.

“Chiropractors and physicians come to me for various reasons, not just because they’re unsure of what they’re looking at on a film,” says Yochum. “Some seek a consult because they want an insightful biomechanical analysis to help guide their treatment planning. Others seek a consult because they don’t want the medico-legal risk of doing their own interpretations. For example, I’ve found in many films that have been sent to me over the years life-threatening abdominal-aortic aneurysms that the senders never noticed. Were a chiropractor to have performed a side-posture adjustment on such a patient, the undetected aneurism very possibly would have ruptured, causing the patient to die.”

Yochum is kept busy with his radiology work to the point that he rarely adjusts patients anymore. That is an activity handled by his colleague, Michael S. Barry, DC, DACBR, with whom Yochum shares a 6,000-square-foot facility.

“Dr Barry’s practice is built around full-time adjusting,” says Yochum. “Many patients are referred to me for treatment; however, I redirect them to Dr Barry.”

Referred images, that is another story. Those go straight to Yochum (Barry gets them whenever Yochum is not available). Most submissions arrive by ground mail in courtesy postage-paid envelopes supplied by Yochum or by overnight courier. Increasingly, though, they are reaching him electronically via the Internet.

“Imaging is going digital,” says Yochum. “Chiropractors have been slower to take advantage of it than have hospital-affiliated physicians, but film is gradually and definitely becoming a thing of the past in our field. And that’s a good thing because, in digital form, it’s infinitely easier and faster to send images back and forth across the country or the entire world. Plus, it eliminates darkroom processing and the costs and hassles associated with that. What’s more, it eliminates the potential for losing films in the mail.”

Once an image reaches Yochum, it is interpreted within 24 hours. He faxes his report of findings the same day it is typed and provides a toll-free telephone line that the referring doctor can call should he wish to discuss the case at greater length.

Going by the Book
If the name Yochum bears a familiar ring, it is perhaps because back in chiropractic college you acquired his massive, two-volume textbook, Essentials of Skeletal Radiology—at least you did if you were in doctor training after 1987, the year Yochum’s seminal work was first published.

“Essentials of Skeletal Radiology quickly became a required radiology textbook at every chiropractic college on earth, and is even in use now at more than 100 medical schools around the world,” says Yochum, who accepted a Baltimore publisher’s offer to write the 1,600-page tome after it became clear to him that no all-encompassing reference text on radiology existed.

“Up until that time, you had to use seven or eight different books to get a comprehensive picture of radiology. The publisher’s concept was to produce a single work concisely covering everything so that you could have all the information in just one place and at a fraction of the cost.”

Never, says Yochum, has there been a radiology-specific book as rich in its clinical orientation: “That’s really its greatest strength—and helps explain why it’s been so successful.” According to Yochum, the first edition alone sold 45,000 copies (roughly a quarter of those to medical physicians); the second edition more than 30,000 more.

“My publisher informed me that medical textbooks are considered to be a success if they sell at least 5,000 first-edition copies before going out of print. We sold that number in the first 3 weeks. It went out of print six times in the first year. It broke every record at that 100-year-old publishing house.”

Now in its third edition and expanded to 1,900 pages containing 5,150 illustrations (most new or updated), Essentials covers the gamut of diseases detectable directly or indirectly through various diagnostic imaging strategies and techniques. It also delves deeply into everything from biomechanics to patient positioning on a Bucky table. There even are chapters on how to write a report of findings, how to predict the outcome of a given intervention, and, unique to Essentials, how to prevent or remedy the presence of clarity-hampering image artifacts.

“In this newest edition, there’s now also a 150-page chapter called ‘Masqueraders of Musculoskeletal Disease’ that describes conditions in the head, chest, abdomen, and soft tissues of the neck capable of mimicking musculoskeletal complaints, particularly back pain,” says Yochum. “Alone, it includes 300 illustrations culled from plain films, nuclear scans, diagnostic ultrasound, MRIs, and CTs.”

Significantly, the book was printed by a medical-publishing house. “It was unprecedented,” Yochum recounts. “But from then on, chiropractors who had book ideas or manuscripts of their own on various other topics were able to go to medical publishing houses to get titles into print. They were no longer barred by those publishers.”

Especially gratifying for Yochum was the acceptance of Essentials by the medical profession, as exemplified by the favorable reviews it received in the respected periodicals Radiology, Skeletal Radiology, and the New England Journal of Medicine. The reason for the warm welcome, he says, is because of the quality of the images gracing the book’s pages.

“The pictures are pristine, as good or better than in any text published previously,” he says. “I shot them myself, so I had total control over the level of detail each would show. I supervised the insertion of the pictures into the book; if they weren’t reproduced correctly, I sent them back and demanded they be done over and gotten right. I must have sent back easily a good couple of thousand of them.”

Yochum calculates he devoted 100 hours a week to the task of assembling the text and illustrations for Essentials. “It was a 7-day-a-week job. I wrote the manuscript in longhand, 10,000 pages in all. After it was inputted to a word-processor by a hired assistant, I spent a full year proofreading it.”

The textbook project started with a query from an executive of the publishing house convinced that no one but Yochum was qualified to craft such a work. However, even with the executive’s unflinching support, Yochum faced an uphill battle to win a contract from the publisher.

“If I had been a medical physician, it would have taken about 90 days for the publisher’s review committee to evaluate the book proposal I developed in response to this invitation. But because I was a chiropractor, the review process took 2 years. During that time, I was investigated from every conceivable angle by the review committee.”

Committee Approval
The committee was attempting to ascertain whether anything in Yochum’s background might give critics an opening to discredit him, thereby chasing off potential buyers of the textbook and bringing scorn on the publishing house. However, in Yochum the committee found an author with impeccable credentials and rock-solid professional integrity.

Yochum points out a herniated disc on an MRI scan, an explanation for his patient’s persistent right arm pain. Yochum often takes time to explain radiographs and MRI scans to patients who are imaged at the Rocky Mountain office.

Yochum, who soon thereafter would become vice president and then president of the American Chiropractic Board of Radiology, had been a rigorous academic since his days as an assistant professor of chiropractic radiology at National College of Chiropractic in Chicago, his alma mater.

Invaluably, the vice chairman of the department of radiology at the nearby Chicago School of Osteopathic Medicine befriended Yochum and took him under wing to teach the young professor about imaging from the vantage point of physicians. The knowledge Yochum acquired he passed along to his students at National College, just as he did later with his students at Logan College of Chiropractic while heading that school’s radiology department.

The offer to write Essentials reached Yochum when he was living in Australia. He had taken up residency “down under” to help the International College of Chiropractic (now the Royal Melbourne Institute of Technology) establish a department of radiology. After returning to the United States to commence work on the book, Yochum joined the Denver practice, which was established by Donald E. Freuden, DC, a classmate of Yochum’s at National College.

However, during the years he spent writing Essentials, Yochum for the most part financially supported himself, his wife, and three children by making the rounds of the national and international lecture circuits.

“I gave approximately 40 lectures a year,” he says. “I’m still giving them, but I’ve cut back to about 20 a year. To date I’ve delivered more than 1,000 lectures worldwide.”

The tally runs higher if you count all those he has delivered in the classroom. Since 1991, Yochum has been a member of the radiology department faculty at the University of Colorado School of Medicine (he has been voted most popular instructor eight times). He is also an adjunct professor of radiology at Southern California University of Health Sciences (formerly Los Angeles College of Chiropractic).

Essentials is not the only book Yochum has written in the course of his career. Two other important textbooks (Essentials of Diagnostic Imaging and Radiology Study Guide) and more than 200 scientific articles published in chiropractic and medical journals bear his byline.

Because of Yochum’s distinguished contributions to the advancement of his specialized field, the American Chiropractic College of Radiology (ACCR) bestowed on him the honor of Fellow in 1996, making Yochum the youngest-ever recipient of that award among the eight DACBRs to be accorded that same laurel since the ACCR began in 1958. Of those distinguished contributions, Yochum points not to his writing of Essentials as the most significant but, rather, to the work he has done to improve the depth and breadth of chiropractic radiology instruction offered to residents.

“I’ve put a lot of effort into upgrading the training of the residents, because they’re the future of our discipline,” he says, letting slip that he someday plans to give up his consult practice in order to devote himself full-time to helping chiropractic colleges enhance their radiology programs.“I feel that the most valuable thing I can do for my profession at this stage of the game is to take a more active roll in the training of the next generation of chiropractors so that they’ll enter practice better equipped than ever before to understand diagnostic imaging.”

Rich Smith is a contributing writer for Chiropractic Products.