Before otolaryngologists embraced image-guided surgery systems as the most efficient and safest way to perform endoscopic sinus surgery, it looked as if these devices weren't cut out for today's ORs. Image-guidance use added 15 to 30 minutes to OR time and $500 to case costs compared to traditional endoscopic technique, according to a 1999 study by Ralph Metson, MD, at the Massachusetts Eye and Ear Infirmary. This is hardly the case you want to make to invest in a six-figure system. So how is it that image-guided navigation is rapidly becoming the gold standard for endoscopic sinus surgery?