BlueCross BlueShield of Tennessee Medical Policy Manual

Positional Magnetic Resonance Imaging (MRI)


Positional magnetic resonance imaging (MRI) also known as kinetic or upright MRI allows imaging of individuals in a range of weight-bearing positions that replicate axial loading of the spine during normal activities such as sitting and standing. This procedure has been proposed as a diagnostic tool for individuals with position-dependent back pain. Determining the cause of back pain is a complex task and positional MRI is purported to be able to detect anatomic spinal anomalies that would otherwise not be detected by conventional (recumbent) MRI. 




The evidence is currently insufficient to evaluate whether the use of positional MRI improves health or treatment outcomes. Studies that correlate positional MRI findings with symptoms and outcomes of treatment are needed. Guidelines for interpreting positional MRI results have not been established due to the lack of data.


American College of Radiology, American Society of Neuroradiology, Society of Computed Body Tomography and Magnetic Resonance, Society for Skeletal Radiology (2018) Practice parameter for the performance of magnetic resonance imaging (MRI) of the adult spine. Retrieved January 29, 2019 from

BlueCross BlueShield Association. Evidence Positioning System. (9:2018). Positional magnetic resonance imaging (6.01.48). Retrieved January 29, 2019 from (7 articles and/or guidelines reviewed)

Diefenbach, C., Lonner, B., Auerbach, J., Bharucha, N., & Dean, L. (2013). Is radiation-free diagnostic monitoring of adolescent idiopathic scoliosis feasible using upright positional magnetic resonance imaging?  Spine, 38 (7), 576-580. Abstract retrieved June 6, 2016 from PubMed database.

Gilbert, J. W., Martin, J. C., Wheeler, G. R., Storey, B. B., Mick, G. E., Richardson, G. B., et al. (2011). Lumbar stenosis rates in symptomatic patients using weight-bearing and recumbent magnetic resonance imaging. Journal of Manipulative and Physiological Therapeutics, 34 (8), 557-561. (Level 4 evidence)

Hedberg, K., Alexander, L., Cooper, K., Hancock, E., Ross, J., and Smith, F. (2013, April) Low back pain: an assessment using positional MRI and MDT. Manipulative Therapy; 18 (2):169-71. Abstract retrieved March 15, 2017 from PubMed database.

Tarantino, U., Fannucci, E., Iundusi, R., Celi, M., Altobelli, S., Gasbarra, E., et al. (2013). Lumbar spine MRI in upright position for diagnosing acute and chronic low back pain: statistical analysis of morphological changes. Journal of Orthopedics and Traumatology, 14, 15-22. (Level 4 evidence)

U.S. Food and Drug Administration. (2000, March). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K994287 (FONAR 360® Scanner). Retrieved March 15, 2017 from

U.S. Food and Drug Administration. (2006, July). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K061930 (Indomitable MRI Scanner). Retrieved October 8, 2010 from

Winifred S. Hayes, Inc. Medical Technology Directory. (2014, September; last update search August 2018). Upright magnetic resonance imaging for diagnosis of spinal disorders. Retrieved January 29, 2019 from (46 articles and/or guidelines reviewed)




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