It may be literally a flip of the coin whether the sinus x-ray is providing a correct diagnosis compared with the gold standard CT sinus.
Depending on what study you look at, the specificity of a sinus x-ray hovers around 50% (how often it correctly states normal sinuses). Sensitivity is a little better at around 80% (how often it correctly detects actual sinusitis).
Several studies have concluded that sinus plain film x-rays are unreliable and no longer routinely indicated for the evaluation of nasal and paranasal sinus disease. When radiographic evaluation is indicated a limited CT series provides superior information.
Take home message?
Do not order a sinus x-ray when evaluating for sinus disease/sinusitis!!! Why bother ordering a test that is going to be wrong almost half the time?
(If a CT sinus comes back normal, the patient most definitely does NOT have acute or chronic sinusitis.)
Reference:
Radiographic evaluation for nasal dysfunction: computed tomography versus plain films. Head Neck. 11 (5), 405-9. 1989
Comparison of sinus x-rays with computed tomography scans in acute sinusitis. Acad Emerg Med. 1 (3), 235-9. 1994
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How about the much greater radiation that a CT scan exposes you too (versus a plain x-ray)? The risk of cancer should be considered too when ordering these tests.
ReplyDeleteIt seems a lot of Doctors are not trained in radiation protection and therefore do not consider radiation exposures to patients. As an xray tech, I have seen many exams move away from plain film to CT and it is true that CT is almost always superior to plain film xrays. However, there has been an increase in Thyroid cancers and you have to wonder whether there is a correlation. It is a fact that the general population receives the majority of their radiation exposure through medical procedures.
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