Restricting Indications for Sinonasal Computed Tomography in Children With Cystic Fibrosis

Abstract

OBJECTIVES To evaluate whether a low rate of exposure to sinonasal computed tomographic (CT) scans can be achieved when strict criteria are applied for their use in children with cystic fibrosis (CF) and to emphasize the importance of limiting radiation exposure in the context of the current longer life expectancy in this group of patients. DESIGN Retrospective chart review. SETTING Tertiary care children's hospital. PATIENTS The study included 277 children who were regularly followed up in the CF clinic in the last 11 years (mean duration of follow up, 7.87 years), 33 of whom underwent sinonasal CT. MAIN OUTCOME MEASURES Indications used for scanning, health professional (ear, nose, and throat specialist or pulmonologist) ordering the test, eventual modifications of ongoing treatment according to CT results, and time lapse between CT scanning and surgery. RESULTS Of 277 children with CF, 33 (12%) underwent a total of 39 sinonasal CT scans during the follow-up period (0.018 scans per patient per year of follow-up). Twenty-nine of the CT scans (74% of all cases, 90% of CT scans ordered by the ear, nose, and throat surgeon) were performed in the preoperative context and demonstrated the extent of the polypoid disease whenever present (26 cases [90%]) and the cause of nasal obstruction (20 cases [69%]). The mean period between the scanning and the surgery was 57 days (range, 0.10-173 days). Computed tomographic scans that were not meant for preoperative planning were performed in 10 cases (26%). The indications were disease evaluation (10%), ruling out a mucocele (5%); pre-lung transplantation status (5%), ruling out an intraorbital complication (3%); and headache investigation (3%). The results of the scans did not modify the management of the disease in those patients. CONCLUSIONS With the use of stringent criteria, it is possible to achieve a low rate of exposure to sinonasal CT scans in the population of children with CF. The main indication should be the preoperative planning regarding anatomy, extent of disease, and sites of nasal obstruction. The use of CT scans for disease evaluation does not seem to appreciably modify the treatment course and could be avoided.

Sinonasal alterations in computed tomography scans in cystic fibrosis: a literature review of observational studies

“…For both children and adults with CF, there are no guidelines to detail the indications for CT scans . In the past, sinonasal CT scans were considered part of the routine sinus assessment of children with CF in some centers .…”

Comprehensive quality of life outcomes for pediatric patients undergoing endoscopic sinus surgery

“…This supports the current practice of attempting nasal endoscopy to diagnose pediatric CRS and monitor disease course, when the child will tolerate the procedure. Postoperative monitoring of disease status with nasal endoscopy before a sinus CT is performed may be especially important in CF-related CRS, since these patients are more likely to develop CRS recurrence and are more likely to receive diagnostic radiation during their lifetimes (36) .…”

CT-abnormalities, bacteriology and symptoms of sinonasal disease in children with Cystic Fibrosis

“…The effective dose of the CT scan used in this study was 1 mSv and although this is reasonably lower compared to the 10-50 mSv, the radiation dose is cumulative in life [22]and children with CF are expected to underdo more than one CT scan during life. For these reasons Cavel and colleagues suggest that in current practice the CT sinus for a child with CF is restricted to pre-operative use [23].…”