Does biplane imaging reduce contrast load, procedural and screening time compared to single‐plane imaging in routine diagnostic coronary angiography?

Abstract

IntroductionDiagnostic coronary angiography utilises radiographic contrast media to delineate epicardial coronary lesions and assess left ventricular function. While contrast media is essential for the radiographic visualisation of coronary vessels, there are certain risks and complications associated with its use. One such complication is contrast-induced nephropathy (CIN). CIN is a life-threatening dose-dependent reaction and is commonly defined as a decrease in renal function 24-48 hours after contrast media administration, with a rise in serum creatinine levels of more than 25% from the baseline (or an absolute increase greater than 0.5 mg/dL) three to five days after the procedure. [1][2][3][4][5][6][7][8][9] Preventative measures for CIN in cardiovascular procedures include pre-hydration, prophylactic administration of N-acetylcysteine and utilisation of iso-osmolar/hypo-osmolar contrast media. However, reducing the volume of contrast media within the procedure was found to be the most effective. [10][11][12][13][14] Cigarroa, et al. 15 and Freeman, et al. 16 both investigated the significance of an adjusted volume of contrast media to patient's body weight and serum creatinine level (maximum radiographic contrast dose (MRCD)) in relation to the occurrence of CIN. CIN developed in 2% of cases when the calculated MRCD for a group of patients was not exceeded, and a 15-fold increase in incidence for a group where MRCD was exceeded. Similarly Rihal, et al. 12 reported a 12% increase in the risk of nephropathy with each 100 mL administered to the patient. As CIN has been found to be the third leading cause of acute renal failure in patients (10% of all admitted cases), it is essential that contrast load is kept to a minimum in any examinations requiring contrast media. 3,17 Coronary angiography can be performed using either singleplane or biplane imaging equipment. Single-plane imaging involves the use of one x-ray tube to acquire images at different angles and requires a separate injection of contrast for each cine angiography run. Biplane imaging utilises two x-ray tubes and is capable of acquiring two simultaneous projections with a single contrast injection. Therefore, it is assumed that contrast load will not only be reduced, but screening time and overall procedural time will be shorter.In biplane imaging, the screening time is inclusive of the total fluoroscopy and cine angiography time for both planes. The screening time should therefore be shorter for biplane imaging than single-plane imaging as it acquires two images simultaneously. Additionally, as the setup of the two C-arms require less movement throughout the procedure, the use of biplane equipment would accordingly assist in reducing procedural time when compared to single-plane imaging. Furthermore, because the runs are calculated from each individual plane, biplane should result in a slightly greater number of cine angiography runs than single-plane imaging. Where single-plane will complete the nine standard projections, biplane will produce ...

Factors contributing to radiation dose for patients and operators during diagnostic cardiac angiography

“…Unsurprisingly, biplane imaging was demonstrated to significantly increase high P KA and OD rates. Biplane imaging uses an additional C‐arm and X‐ray source to acquire images and it has previously been demonstrated to increase FT, DA and P KA . The study by Lin et al .…”

Impact of biplane versus single-plane imaging on radiation dose, contrast load and procedural time in coronary angioplasty

“…On the other hand, the use of biplane equipment was assumed to be a practical measure to significantly reduce contrast load when compared with single-plane equipment [1, 5-7, 12, 18, 23]. The study by Sadick et al [14] reported a small but significant reduction in contrast load with biplane imaging, compared with single-plane imaging, in a much larger group of patients undergoing diagnostic coronary angiography. This study showed that there was a small but non-significant reduction in contrast load with biplane imaging (BP: 166.8¡62.9 ml vs SP: 176.8¡66.0 ml, p50.052).…”

“…A previous study comparing biplane and single-plane imaging in 1156 diagnostic coronary angiography procedures found a small, but notable, reduction in contrast load accompanied by significantly longer table times and screening times with biplane imaging, although radiation dose was not examined [14].…”

Impact of single‐plane versus Bi‐plane imaging on procedural time, fluorescence time, and contrast medium volume in retrograde chronic total occlusion percutaneous coronary intervention

“…A previous study showed bi‐plane imaging resulted in a greater radiation dose and a longer procedural time and delivered a non‐significant reduction in contrast load than single‐plane imaging . Another study comparing bi‐plane and single‐plane imaging in diagnostic coronary angiography procedures found a small, but notable, reduction in contrast load accompanied by significantly longer procedural time with bi‐plane imaging . These findings did not support the commonly perceived advantages of using bi‐plane imaging in diagnostic angiography and simple coronary intervention procedures.…”