Bi-plane and single plane angiography: a study to compare contrast usage and radiation doses for adult cardiac patients in diagnostic studies

Smith, Keith; Crowhurst, J.; Walters, D.; Starkey, Debbie

doi:10.1259/bjr.20180367

Cited by 9 publications

(7 citation statements)

References 19 publications

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“…The clinical indication of the procedure can be critically reviewed and high-risk patients may benefit from more intense or prolonged postprocedural monitoring of urine output and retention parameters. Contrast media volume is a key factor for the development of CIN, especially in high-risk patients [ 34 ] and may be managed accordingly: the use of biplane angiography systems helps to reduce contrast media exposure [ 35 ]. There are technical devices which are efficient in reducing contrast media over-injection [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

National Cardiovascular Data Registry-Acute Kidney Injury (NCDR) vs. Mehran risk models for prediction of contrast-induced nephropathy and need for dialysis after coronary angiography in a German patient cohort

et al. 2021

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Background Contrast-induced nephropathy (CIN) is a major adverse event in patients undergoing coronary angiography. The Mehran risk model is the gold-standard for CIN risk prediction. However, its performance in comparison to more contemporary National Cardiovascular Data Registry-Acute Kidney Injury (NCDR-AKI) risk models remains unknown. We aimed to compare both in this study. Methods and results Predictions of Mehran and NCDR-AKI risk models and clinical events of CIN and need for dialysis were assessed in a total of 2067 patients undergoing coronary angiography with or without percutaneous coronary intervention. Risk models were compared regarding discrimination (receiver operating characteristic analysis), net reclassification improvement (NRI) and calibration (graphical and statistical analysis). The NCDR risk model showed superior risk discrimination for predicting CIN (NCDR c-index 0.75, 95% CI 0.72–0.78; vs. Mehran c-index 0.69, 95% CI 0.66–0.72, p < 0.01), and continuous NRI (0.22; 95% CI 0.12–0.32; p < 0.01) compared to the Mehran model. The NCDR risk model tended to underestimate the risk of CIN, while the Mehran model was more evenly calibrated. For the prediction of need for dialysis, NCDR-AKI-D also discriminated risk better (c-index 0.85, 95% CI 0.79–0.91; vs. Mehran c-index 0.75, 95% CI 0.66–0.84; pNCDRvsMehran < 0.01), but continuous NRI showed no benefit and calibration analysis revealed an underestimation of dialysis risk. Conclusion In German patients undergoing coronary angiography, the modern NCDR risk model for predicting contrast-induced nephropathy showed superior discrimination compared to the GRACE model while showing less accurate calibration. Results for the outcome ‘need for dialysis’ were equivocal. Graphic abstract

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Section: Discussionmentioning

confidence: 99%

National Cardiovascular Data Registry-Acute Kidney Injury (NCDR) vs. Mehran risk models for prediction of contrast-induced nephropathy and need for dialysis after coronary angiography in a German patient cohort

et al. 2021

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“…[56][57][58] It has also been reported that biplane fluoroscopy uses less contrast dye than single-plane fluoroscopy at the expense of higher radiation dose, as two X-ray images can be acquired by the biplane system with a single injection of contrast dye. [59,60] Given that the excessive use of contrast dye is the main cause of acute kidney injury, [61,62] biplane fluoroscopy may be more appealing to patients with renal impairment, whereas single-plane imaging may be preferred by those without. In this context, future additional studies comparing the effects of biplane versus single-plane imaging by our BXI system on the overall radiation dose, contrast load, and procedural time with our microrobotic guidewire, EMA, and MSA systems simultaneously involved are worth of investigation.…”

Section: Discussionmentioning

confidence: 99%

An Electromagnetically Controllable Microrobotic Interventional System for Targeted, Real‐Time Cardiovascular Intervention

Hwang

Jeon

Kim

et al. 2022

Adv Healthcare Materials

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Robotic magnetic manipulation systems offer a wide range of potential benefits in medical fields, such as precise and selective manipulation of magnetically responsive instruments in difficult‐to‐reach vessels and tissues. However, more preclinical/clinical studies are necessary before robotic magnetic interventional systems can be widely adopted. In this study, a clinically translatable, electromagnetically controllable microrobotic interventional system (ECMIS) that assists a physician in remotely manipulating and controlling microdiameter guidewires in real time, is reported. The ECMIS comprises a microrobotic guidewire capable of active magnetic steering under low‐strength magnetic fields, a human‐scale electromagnetic actuation (EMA) system, a biplane X‐ray imaging system, and a remote guidewire/catheter advancer unit. The proposed ECMIS demonstrates targeted real‐time cardiovascular interventions in vascular phantoms through precise and rapid control of the microrobotic guidewire under EMA. Further, the potential clinical effectiveness of the ECMIS for real‐time cardiovascular interventions is investigated through preclinical studies in coronary, iliac, and renal arteries of swine models in vivo, where the magnetic steering of the microrobotic guidewire and control of other ECMIS modules are teleoperated by operators in a separate control booth with X‐ray shielding. The proposed ECMIS can help medical physicians optimally manipulate interventional devices such as guidewires under minimal radiation exposure.

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“…The feasibility of angioFFR (an earlier version of this prototype) estimated from single plane acquisitions and agreement of angioFFR and FFR have been previously reported in a study of 100 lesions in 73 patients [11], but our study expanded on these findings, as we could confirm that angi-oFFR calculated from data acquired in biplane mode yielded to similar results as those from data acquired in single plane mode. This is an important result, since many institutions routinely use biplane C-arm systems for coronary angiographic imaging [14][15][16].…”

Section: Discussionmentioning

confidence: 99%

“…Validation studies of angiography-derived FFR have been carried out with single plane or biplane C-arm angiography systems [6,11], but it remains unclear whether both acquisition modes yield to similar results. Biplane systems are used for coronary angiography in many institutions [14][15][16]. They offer the advantage of allowing the acquisition of two simultaneous views of a vessel during the same heartbeat, and with one contrast injection, where single plane systems require two separate contrast injections to acquire two views.…”

Section: Introductionmentioning

confidence: 99%

Agreement between single plane and biplane derived angiographic fractional flow reserve in patients with intermediate coronary artery stenosis

Ando

Otani²,

Redel

et al. 2021

Heart Vessels

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Fractional flow reserve (FFR) is often used to evaluate the physiological severity of intermediate coronary stenoses, but less-invasive assessment methods are desirable. We evaluated the feasibility of angiographic FFR (angioFFR) calculated from two projections acquired simultaneously by a biplane C-arm system and angioFFR calculated from two projections acquired independently by one plane of the same biplane C-arm system. AngioFFR was validated against FFR in terms of detection of hemodynamically relevant coronary artery stenoses. Twenty-two Patients who underwent angiography and FFR for coronary artery disease were included. We used a non-commercial prototype to calculate biplane angioFFR for 22 vessels (19 LAD, 1 LCx, 2 RCA) and single plane angioFFR for 17 of the same 22 vessels. FFR < 0.8 was measured in 8 vessels. The Pearson correlation coefficients with FFR were 0.55 for single plane angioFFR and 0.61 for biplane angioFFR and the diagnostic accuracies were 88% (95% CI 73-100%) for single plane angioFFR and 86% (95% CI 72-100%) for biplane angi-oFFR. Bland-Altman plots revealed that compared with FFR, the limits of agreement for single plane angioFFR were -0.07 to 0.19 (mean difference 0.06, p = 0.002) and the limits of agreement for biplane FFR were -0.09 to 0.15 (mean difference 0.03, p = 0.03). In conclusion, angioFFR calculated from single or biplane acquisitions by a biplane C-arm is feasible and may evolve to a tool for less invasive imaging-based assessment of myocardial ischemia.

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Bi-plane and single plane angiography: a study to compare contrast usage and radiation doses for adult cardiac patients in diagnostic studies

Cited by 9 publications

References 19 publications

National Cardiovascular Data Registry-Acute Kidney Injury (NCDR) vs. Mehran risk models for prediction of contrast-induced nephropathy and need for dialysis after coronary angiography in a German patient cohort

National Cardiovascular Data Registry-Acute Kidney Injury (NCDR) vs. Mehran risk models for prediction of contrast-induced nephropathy and need for dialysis after coronary angiography in a German patient cohort

An Electromagnetically Controllable Microrobotic Interventional System for Targeted, Real‐Time Cardiovascular Intervention

Agreement between single plane and biplane derived angiographic fractional flow reserve in patients with intermediate coronary artery stenosis

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