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Stop doing x-rays for sinuses
Written By: Dr Ibrahim Issa MD. Otolaryngology Consultant , Laryngologist & Phonosurgeon
Edited By: Dr Ali Alsmair MD. Radiology Consultant.
Edited By: Dr Mohammad Murad MD. Otolaryngology Specialist.
Diagnosis for sinus related problems depends mostly on the clinical presentation which includes a detailed history from the patient and a detailed examination of the ear, nose, and throat, which includes endoscopy of the nose if possible.
Many times we need to do imaging to rule in or out some problem, many times we need to do imaging for the sinuses to see inside the sinuses which is not seen by either exam or by endoscopy, because sinuses are bony cavities that comes in layers, cavity after another, the thing that makes looking on the outer wall of one sinus not really diagnostic.
The question is what is the best type of imaging for sinuses, everybody will say it’s the CT scan, but the problem that we find many doctors asking for plane X-rays for the sinuses claiming that if the problem is not sever we don’t need to do an expensive scan, and if the problem is acute we don’t need to look for chronic changes, and that Ct of the sinuses exposes the patient to a very high dose of radiation compared to plane X-rays, we also find many of the insurance companies asking for X-ray for the sinuses to see if there is any problem before giving the permission to do the more expensive CT scans….. And here is my answer…
X-rays for the sinuses and nose problems are very important and needed in many problems like nasal fractures, foreign bodies, and assessment of the size of the adenoids. On the other hand, X-rays for the diagnosis of sinusitis and other sinus problems are obsolete and do not help in the diagnosis and treatment of sinus problem
s.
Let’s imagine this simple experiment; you need five of your friends for this test, you take and X-ray for your hand, the result is a clear white hand bones, put your friend’s hand behind your hand and take another X-ray, the result is another white bones, then repeat the test with adding another hand behind your hands every time, you will notice that the picture of the white hand bones will be less clear, bones will start compacting over each other, no demarcation will be seen between them, you will not know which hand is yours and which is your friends. Sinuses and the nose form multiple cavities of bone filled with air, these cavities are surrounding each other and each one is behind the other, it’s like a maze of many small and irregular rooms, if we did an X-ray for the sinuses we will not be able to know on which sinus we are looking and the bone shadow will be overlying the air shadow making the diagnosis very difficult and if you are looking for detailed anatomy changes like the shape of the turbinates and its relation to the sinuses it would be impossible to have an answer with a plane X-ray.
On the other hand, CT scan (computed tomography scan) gives multiple pictures, each one is a photo of a thin sliced cut of the body, which gives a very detailed view for all the sinuses and their contents from all directions.
In cases of suspected acute sinusitis, most of the cases are diagnosed by clinical presentation and doing X-ray will not add anything to the diagnosis, so why to do a low radiation X-ray while you can treat the patient without any radiation, but when the infection is complicates, X-ray will not help to view the complication while CT scan can show everything.
Endoscopy of the nose and sinuses is not a substitute for CT scan because by the scope you will see the outer wall of the sinus and will not see either the inside of the sinus nor the other sinus behind. Endoscopy is very important for sinus problems diagnosis but sometimes we need imaging, and then, only CT is valuable not the plane X-ray.
Radiation exposure of plane X-ray of the sinuses is 0.3mSv, while radiation exposure of CT scan of the sinuses is 0.7mSv, so CT scan is also considered a low radiation exposure compared to abdominal CT scans which can reach 8.00mSv, this is the difference in the radiation exposure that most doctors are claiming to safe the patient by not getting them exposed to it, but they forget that they usually go back and do CT scan when they want to do the surgery or when they don’t get a diagnosis by the X-ray, or they keep repeating the X-ray which increases the radiation exposure more and more. From my point of view, a moderate exposure to radiation that gives a help in the diagnosis and treatment is much safer than and minimum radiation without any benefit.
Written By: Dr Ibrahim Issa MD. Otolaryngology Consultant , Laryngologist & Phonosurgeon
Edited By: Dr Ali Alsmair MD. Radiology Consultant.
Edited By: Dr Mohammad Murad MD. Otolaryngology Specialist.
