Improving CT Sinus Reporting for Endoscopic Sinus Surgery Using the CLOSE Criteria: A Quality Improvement Project

Introduction Pre-operative CT sinus reports are essential for identifying high-risk anatomical variants during functional endoscopic sinus surgery (FESS). The widely accepted CLOSE criteria provide a structured framework for this reporting. The objective of this quality improvement (QI) project was to assess the completeness of CT sinus reporting for patients likely to undergo FESS using the CLOSE framework and introduce interventions to standardise reporting and improve patient safety. Methods This three-cycle QI project was conducted at a single NHS health board, reviewing 92 retrospective CT sinus reports between February 2025 and September 2025. Educational interventions were implemented following each cycle, including the distribution of a poster to relevant radiology departments and an NHS-partnered teleradiology company, the collection of feedback, and the reinforcement of changes at departmental meetings. An accompanying survey was sent out to ENT consultants to gather qualitative data. Compliance rates between cycle one and cycle three were compared using the chi-square test. Results Comparing cycle one to cycle three, a significant increase in compliance was observed. Full documentation of all CLOSE components rose from a baseline of 8/51 (15.7%) to 11/21 (52.4%). For reports demonstrating high-risk anatomical variants relevant to surgical planning, overall compliance rose from 5/51 (9.8%) to 9/21 (42.9%) (χ²=10.375, p<0.01). Our predominantly Scottish cohort showed that Keros type II and sellar sphenoid sinus pneumatisation were the most common findings, with 36/92 (39%) patients exhibiting supraorbital pneumatisation. The consultant survey (n=11) showed that identifying high-risk anatomy was the most important feature (11/11 (100%) respondents). While 9/11 (82%) respondents were familiar with the CLOSE framework, 5/11 (45%) considered the existing CLOSE criteria only partly sufficient. Conclusion The successful implementation of a systematic, recognised checklist like the CLOSE criteria substantially improved the quality and consistency of CT sinus reporting. This replicable methodology enhances surgical planning, improves patient safety, and strengthens communication between radiology and ENT departments.