Appropriate Terminology for Nose X-Ray
The appropriate name is "radiography of the paranasal sinuses" or "paranasal sinus radiographs," though this imaging modality is now largely obsolete and has been replaced by CT scanning in clinical practice. 1
Standard Nomenclature
- The traditional plain film examination is formally called "radiography paranasal sinuses" in medical terminology 1
- Common radiographic views historically included the Waters (occipito-mental), Caldwell (occipito-frontal), and lateral projections 2
- The Waters view specifically evaluates the maxillary antra and was considered the single best projection for sinus evaluation 1
Current Clinical Context and Limitations
Plain radiographs of the sinuses are no longer recommended for most clinical scenarios because they have been supplanted by CT imaging due to superior anatomic detail and diagnostic accuracy 1
Key Limitations of Plain Radiography:
- Poor sensitivity and specificity compared to CT, with false-negative rates of 32% and false-positive rates of 49.2% 1
- Limited detection of mucosal thickening due to overlapping osseous structures 1
- Inadequate visualization of the ethmoid and sphenoid sinuses, which are poorly depicted on standard views 1, 3
- Difficult to perform in young children who cannot cooperate for proper positioning 1
When Plain Films Are NOT Appropriate
- Acute bacterial rhinosinusitis: The American Academy of Otolaryngology-Head and Neck Surgery guidelines explicitly state that radiographs are unnecessary for patients with clinical diagnosis of acute bacterial rhinosinusitis 1
- Presurgical planning: CT provides the necessary anatomic detail for functional endoscopic sinus surgery, making plain films inadequate 1
- Suspected complications: Plain radiographs cannot adequately evaluate orbital or intracranial complications 1
Radiation Exposure Consideration
- Plain radiography delivers approximately 0.1 to 0.2 mSv of radiation exposure 1
- This is comparable to low-dose CT protocols, which further diminishes the rationale for using plain films 1
Important Clinical Pitfall
Ordering "nose X-rays" in modern practice is generally inappropriate because CT scanning has become the gold standard for sinonasal imaging when imaging is clinically indicated, providing both superior bone detail and soft-tissue resolution 1