Diagnosing sinusitis by X-ray: is a single Waters view adequate?

OBJECTIVE: To determine whether a single Waters view (occipito-mental) radiograph could be substituted for a four-view sinus series to diagnose sinusitis, and to determine the inter- and intraobserver variabilities for sinus radiography. DESIGN: Radiographs were interpreted by radiologists blinded to the clinical history, and results were recorded on a standardized form. SETTING: Veterans Affairs Medical Center. PARTICIPANTS: Staff attending radiologists, an attending radiologist with special training in skull radiology, and a senior radiology resident. MEASUREMENTS AND MAIN RESULTS: The agreement between the Waters view and the four-view sinus series was moderate to substantial (simple agreement = 75-84%, kappa = 0.5-0.68). However, agreement varied by sinus and, after correction for chance agreement, was substantial only for the maxillary sinuses (kappa = 0.72-0.87). Intraobserver agreement (kappa = 0.72-0.84) was superior to interobserver agreement (kappa = 0.49-0.59) for the four-view sinus series. CONCLUSIONS: Substituting a single Waters view for a four-view sinus series may be an acceptable strategy for diagnosing maxillary sinusitis.

Duke Scholars

Author John Wiley Williams Jr. Medicine, General Internal Medicine

Author David Lee Simel Medicine, General Internal Medicine