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New Recommendations for Chronic Rhinosinusitis

Imaging guidelines downgrade X-ray use

Sunil Ram, MD

Sunil Ram, MD

In 2012, the Agency for Healthcare Research and Quality recommended downgrading X-ray imaging to “usually not appropriate” for sinonasal disease and acute and chronic sinusitis.

“Studies have shown that X-ray for acute sinusitis is not helpful and unnecessarily exposes the patient to radiation,” says Sunil Ram, MD, a neuroradiologist at Scottsdale Medical Imaging (SMIL). “A patient should only be imaged in the setting of chronic sinusitis in order to confirm the diagnosis, evaluate for anatomic derangements and assist in potential surgical planning.”

Ram adds that SMIL encourages utilization of the American College of Radiology appropriateness criteria for sinonasal disease outlined in 2013. The ACR recommends CT as the imaging method of choice for the paranasal sinuses and states that coronal CT imaging gives the best overall anatomic detail.

“SMIL’s approach to head and neck imaging includes having all studies exclusively read by board-certified neuroradiologists,” Ram says. “Our introduction of low-dose techniques has reduced radiation exposure by up to 70 percent, without negatively affecting diagnostic image quality or assessment of anatomical structures.”

In those cases where anatomic variation is suspected, imaging for diagnosis and surgical planning becomes essential, Ram says.

“We will often find anatomic variations that expose patients to chronic sinusitis. Many of these patients will be successfully treated with functional endoscopic sinus surgery,” he says. •

Agency for Healthcare Research and Quality, National Guideline Clearinghouse. ACR
appropriateness criteria sinonasal disease.

Cornelius Rebecca, Martin Jamie, Wippold Franz, et al. ACR appropriateness criteria sinonasal
disease. Journal of the American College of Radiology. 2013;10(4):241-246.