Preoperative Computed Tomography Utilization in Patients Undergoing Balloon Sinus Dilation.

Importance: Timely computed tomography (CT) imaging is a requirement before performance of sinus surgery, including balloon sinus dilation (BSD). Objective: To determine adherence to practice guidelines for use of CT imaging before BSD procedures. Design, Setting, and Participants: This cross-sectional study used Medicare claims data to identify and include otolaryngologists who each performed at least 11 BSDs from January 1, 2022, to December 31, 2023. Data were analyzed from April 1 to September 9, 2025. using IBM-SPSS statistics version 29 and R 4.3.2. Main Outcome(s) and Measure(s): Percentage of physicians performing BSD without CT imaging available within 1 year of the procedure in greater than 10% of procedures (outliers). Physician variables were explored for potential association with outlier status. Results: The analysis evaluated 490 otolaryngologists (29 female [5.9%] and 460 male [94.1%] individuals) who performed at least 10 BSD procedures annually in a total of 19 692 patients. Preprocedure CT imaging was not available within 1 year prior of BSD for 2905 patients (15%). In all, 156 otolaryngologist-participants (31.8%) were identified as outliers; notably, 30 of these (6.1%) accounted for more than 50% of cases without preprocedure CT imaging, affecting 1880 patients (9.5%) undergoing BSD. Moreover, 42 participants (8.6%) accounted for 47.5% of all missed CTs. Conclusion and Relevance: This cross-sectional study found that most otolaryngologists adhered to clinical consensus by obtaining CT imaging before performing BSD. However, a substantial portion did not obtain CT imaging before BSD and therefore, did not adhere to standard practice guidelines. These findings demonstrate the need for improved monitoring of adherence to the standard of practice.