Full Spine AP (Stitching)

Stitching AP panoramic stitching STD
Objective

Entire spine in AP (C1 → iliac crests) for global frontal alignment assessment, Cobb angle measurement, scoliotic curve assessment, pelvic obliquity and Risser index.

Positioning

Patient standing with back against the detector.
Arms along the sides.
Feet shoulder-width apart.
Symmetrical alignment to the frontal plane.
Sequential acquisition with software stitching.
Central ray: perpendicular to the IR.

Centering

T6–T7 (spine centre)

DR Parameters

80–90 kV · 15–25 mAs per segment
SID ~150–180 cm · grid required

CR Parameters

80–90 kV · 25–40 mAs per segment · SID ~150–180 cm

Quality criteria

Entire spine from C1 to the iliac crests included.
Pelvis included bilaterally for assessment of pelvic obliquity and Risser index.
Symmetrical alignment.
No misalignment between segments.

Common errors

Pelvis and iliac crests not included.
Movement between acquisitions.
Segment misalignment.
Patient rotation.

Practical notes

Always include the iliac crests: essential for calculating the Risser index (skeletal maturity) and for assessing pelvic obliquity in scoliosis.
Increased SID to reduce geometric magnification.
Always perform weight-bearing.
Paediatric/adolescent patient (<18 years): routine gonadal shielding no longer recommended (AAPM 2021); apply thyroid shield (lead collar) in AP projections including the cervico-thoracic segment; tight collimation; prefer low-dose systems (EOS/LODOX) if available — estimated dose reduction ~85% vs conventional X-ray.