Although computed tomography (CT imaging) is an essential diagnostic tool for patients with paranasal sinus disease the test is associated with significant costs, radiation exposure, and overuse concerns.  To help define appropriate use of CT imaging an expert panel was convened and areas of clinical consensus were identified using a 3 round modified Delphi method. Statements reaching consensus included (a) CT imaging is not indicated for an uncomplicated "cold" lasting less than 10 days or for uncomplicated acute sinusitis in children under age 3 years, (b) CT imaging is indicated for chronic sinusitis in children that persists despite adenoidectomy or medical management, and (c) CT imaging is indicated for at any age for suspected tumor, complications from sinusitis, or prior to sinus surgery.  The presenters stress that the diagnosis of uncomplicated, acute bacterial sinusitis in children should be based on clinical signs and symptoms, not on CT imaging.