Private Practice Section, APTA

Physical therapists are experts in the musculoskeletal system, and typically use patient history and a good physical exam to come to a diagnosis and treatment plan. However, PTs are increasingly using diagnostic imaging as they become the practitioner of choice for musculoskeletal injuries. Many PTs have access to diagnostic ultrasound right in the clinic, and in some practice settings like the military, and certain ACOs, therapists have the ability to order imaging like x-rays, CT scans and MRIs.

The research indicates that PTs are effective in using their ability to order imaging when it exists. A study of 108 imaging orders by PTs providing musculoskeletal primary care in a direct-access sports physical therapy clinic found that advanced diagnostic imaging was ordered appropriately in over 80% of cases.

So, PTs are good at appropriately ordering imaging, but how does it improve treatment? A case study published in the July 2015 issues of the Journal of Manual & Manipulative Therapy gives a good illustration:
The patient was a very active dentist who had chronic mid and upper back pain. He had a known history of benign neural tissue tumors of his head and upper back region, but no specific diagnosis for his back pain had been provided. After examination, the PT decided to start treatment for the patient's back pain, but also order x-rays and an MRI of the symptomatic part of the patient's spine. The MRI showed a previously undiscovered meningioma, or benign tumor of the membrane that covers the spinal cord.

The benefit to this patient was that the PT could continue treatment without making referrals and waiting for someone else to order the images. Also, once the tumor was discovered, the PT could select exercises and manual techniques that would help the patient, but avoid putting stress on the area of the tumor. It also allowed the PT to educate the patient on fitness activities that would be safe and appropriate.

The case study has a quote that sums up the benefits of imaging combined with PT nicely: "Orthopaedic physical therapists have high levels of musculoskeletal expertise and extensive knowledge of typical patterns and behaviors of musculoskeletal conditions. These competencies and experiential knowledge enable them to appropriately recognize situations requiring additional diagnostic screening for non-musculoskeletal pathology. This case demonstrates how privileges to order musculoskeletal imaging studies assisted the physical therapist in providing optimal, patient-centered care. The physical therapist in this case was able to continue treatment without multiple referrals back to the medical provider to obtain imaging, and so provided more cost-efficient and convenient care."

Reference article and case study:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5046964/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4534847/