2018 Section 5 - Rhinology and Allergic Disorders

Batra et al.

FIGURE 1. Geographic location of the 320 participating physicians. Eleven survey respondents did not provide their location.

FIGURE 2. Number of sinus CT scans ordered by respondents in a typical week. CT = computed tomography.

Clinical practice parameters The percentage of clinical practice devoted to rhinology was as follows: < 25% (30; 9.1%), 25% to 50% (124; 37.6%), 51% to 75% (69; 20.9%), and > 75% (107; 32.4%). The number of patients with nasal and sinus complaints seen in a typical week was as follows: < 25 (60; 18.2%), 26 to 50 (146; 44.4%), 51 to 75 (80; 24.3%), 76 to 100 (29; 8.8%), and > 100 (14; 4.3%). Figure 2 illustrates the number of sinus CT scans ordered in a typical week. CT utilization variables Table 1 lists the frequency of times practicing otolaryngol- ogists obtain confirmatory CT imaging for CRS prior to initiating medical therapy, after first and second rounds of medical therapy, and in patients with severe headaches. It also provides the frequency of times the respondents ob- tain plain films and magnetic resonance imaging (MRI) for diagnosis of CRS. The respondents considered a typ- ical diagnostic sinus CT scan as follows: 5-mm axial (1; 0.3%), 5-mm coronal (33; 10.1%), 3-mm axial (8; 2.4%), 3-mm coronal (66; 20.1%), 3-mm coronal and axial (100;

30.5%), 2-mm axial with reconstruction (69; 21.0%), and 1-mm axial with reconstruction (51; 15.5%). On average, the total number of CT scans obtained prior to proceeding with primary FESS in a typical patient, in- cluding those ordered by primary care, urgent care, or other providers, was as follows (values are number of scans in number of respondents): 0 in 1 (0.3%), 1 in 193 (58.8%), 2 in 120 (36.6%), 3 in 9 (2.7%), 4 in 0 (0%), and 5 or more in 5 (1.5%). Overall, 131 respondents (40.1%) obtained a new CT scan for image guidance prior to surgery. The types of sinus CT scan obtained prior to FESS are listed in Figure 3. The frequency of usage of surgical navigation was < 25% of the time in 110 (33.6%), 25% to 50% of the time in 60 (18.3%), 51% to 75% of the time in 71 (21.7%), and > 75% of the time in 86 (26.3%). In the group above, 35 (10.7%) did not use navigation during FESS. Overall, 26 respondents (8.0%) used intraoperative CT imaging during FESS. The location of CT imaging acquisition was as follows: hospital radiology (252; 76.4%), free-standing imaging center (147; 44.5%), and in-office CT scanner (79; 23.9%). An in-office CT scanner and X-ray machine was owned by

International Forum of Allergy & Rhinology, Vol. 5, No. 6, June 2015

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