Standing X-rays

Standing (weight-bearing) X-rays are simply X-rays taken while you are upright rather than lying down, so the spine is imaged under the load of gravity. Because posture and alignment change once the spine has to support the body's weight, standing views often reveal more about a person's real-world problem than films taken lying flat. They are widely used to assess alignment, curvature and the way the spine balances.

The imaging is the same as any X-ray — a beam passes through the body and casts a shadow of the bones onto a detector — but you are standing in your natural posture. Under load, a vertebra that has slipped forward may show its true position, the spacing of the discs reflects everyday weight-bearing, and the overall curves of the spine appear as they are when you stand. Front-to-back and side-on views are usually taken to judge alignment in both planes.

You stand still in a natural, relaxed posture while the radiographer positions you and takes the images, which is quick and painless. You may be asked to hold a particular stance, look straight ahead, or place your arms in a set position so that the alignment can be measured consistently. As with any X-ray, the dose is low, and you will be asked about the possibility of pregnancy.

Many spinal problems only make sense when the spine is bearing weight. Standing X-rays can show a slip that hides when lying down, reveal loss of the normal curves, and are the basis for the measurements used to plan treatment of deformity and to check alignment after surgery. They provide information a lying-down scan cannot, which is why upright films are so often requested for problems of posture and balance.

• —Royal College of Radiologists — iRefer: Making the Best Use of Clinical Radiology
• —UK Health Security Agency — Ionising Radiation: Patient Dose Information
• —British Association of Spine Surgeons (BASS)

This information is for general patient education and is not a substitute for an individual consultation. Always seek personalised advice from a qualified spinal specialist.