OBJECTIVE: The literature pertaining to full-spine radiography was reviewed to clarify its current role in clinical practice, to identify appropriate parameters for patient selection criteria, to evaluate the validity of spinographic analysis procedures, and to review the latest technological advancements in radiation protection and radiographic technology.

DATA SOURCES: The English language literature search included chiropractic textbooks, technique manuals and position papers as well as references from MEDLINE, Chiropractic Research Archives Collection (CRAC) and Chiropractic Literature Analysis and Retrieval System (CHIROLARS). References from non-indexed sources were reviewed from sources obtained in the indexed literature. Current texts on radiographic technology, radiation biology and radiation physics also were reviewed.

STUDY SELECTION: The literature was reviewed by a single reviewer. All chiropractic references obtained were referenced. Nonchiropractic references that addressed relevant related topics were also included.

DATA EXTRACTION: This study was primarily a qualitative review of the literature. A single observer extracted quantitative data only from controlled studies that examined validity, inter- and intraobserver reliability, and clinical relevance.

DATA SYNTHESIS: The conclusions and recommendations in this review are based primarily on the work of experts in the field and well-established principles of radiation biology, radiation protection and radiation physics.

CONCLUSIONS: Full-spine radiography and spinographic analysis are controversial procedures in chiropractic. An extensive review of the literature reveals that the role of full-spine radiography is well established. With proper patient selection, careful attention to technical detail and utilization of several technological advancements, full-spine radiography is an effective diagnostic and analytic procedure with an acceptable risk/benefit ratio. Although the reliability of certain spinographic parameters has been established, many questions remain regarding the validity and clinical relevance of those parameters.

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