Dear Editor:

We read with great interest the recent paper by Schweitzer et al. recently published in Childs Nervous System [1]. The authors review their experience with routine skull X-rays in the evaluation of craniosynostosis (CS). They describe 127 cases, of which most were single-suture CS (such as sagittal, metopic, and coronal), and describe the typical X-ray findings. The authors stress the advantage of X-rays over CT scans in regard to radiation exposure.

Despite the recommendations by the authors, we think that clinical diagnosis is the main diagnostic tool needed to make a definite diagnosis of single-suture CS. In our opinion, there is no place for any imaging (including X-rays) for such cases.

The role of X-rays for demonstrating “blood vessels” within the bone has limited clinical impact and adds to unnecessary radiation exposure of babies.

In our view, imaging should be spared for non-typical cases, such as those with anterior plagiocephaly that do not fit “classical” coronal synostosis. We recently published our experience with frontosphenoid synostosis and highlighted the importance of 3D-CT for this pathology [2].

For all typical CS, including diagnosis of benign positional plagiocephaly (BPP), we think that any imaging poses unnecessary cost burden on the medical system and exposes babies to unnecessary radiation.