Diagnosing sinusitis by X-ray

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Abstract
Objective:To determine whether a single Waters view (occipitomental) 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.

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