title: Diagnosing sinusitis by X-ray: is a single Waters view adequate?
abstract: 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.
  
  
  METHODS
  Radiographs were interpreted by radiologists blinded to the clinical history, and results were recorded on a standardized form.
  
  
  METHODS
  Veterans Affairs Medical Center.
  
  
  METHODS
  Staff attending radiologists, an attending radiologist with special training in skull radiology, and a senior radiology resident.
  
  
  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.
authors.affiliation: Center for Health Services Research in Primary Care, Durham VAMC, North Carolina.
authors.forename: J W
authors.initials: JW
authors.lastname: Williams
authors.forename: L
authors.initials: L
authors.lastname: Roberts
authors.forename: B
authors.initials: B
authors.lastname: Distell
authors.forename: D L
authors.initials: DL
authors.lastname: Simel
mesh_terms: D000328:Adult; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011859:Radiography / Q000379:methods / Q000592:standards; D015203:Reproducibility of Results; D012852:Sinusitis / Q000000981:diagnostic imaging*