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

Coronary angioplasties can be performed with either single-plane or biplane imaging techniques. The aim of this study was to determine whether biplane imaging, in comparison to single-plane imaging, reduces radiation dose and contrast load and shortens procedural time during (i) primary and elective coronary angioplasty procedures, (ii) angioplasty to the main vascular territories and (iii) procedures performed by operators with various levels of experience. This prospective observational study included a total of 504 primary and elective single-vessel coronary angioplasty procedures utilising either biplane or single-plane imaging. Radiographic and clinical parameters were collected from clinical reports and examination protocols. Radiation dose was measured by a dose-area-product (DAP) meter intrinsic to the angiography system. Our results showed that biplane imaging delivered a significantly greater radiation dose (181.4+/-121.0 Gycm(2)) than single-plane imaging (133.6+/-92.8 Gycm(2), p < 0.0001). The difference was independent of case type (primary or elective) (p=0.862), vascular territory (p=0.519) and operator experience (p=0.903). No significant difference was found in contrast load between biplane (166.8+/-62.9 ml) and single-plane imaging (176.8+/-66.0 ml) (p=0.302). This non-significant difference was independent of case type (p=0.551), vascular territory (p=0.308) and operator experience (p=0.304). Procedures performed with biplane imaging were significantly longer (55.3+/-27.8 min) than those with single-plane (48.9+/-24.2 min, p=0.010) and, similarly, were not dependent on case type (p=0.226), vascular territory (p=0.642) or operator experience (p=0.094). Biplane 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. These findings did not support the commonly perceived advantages of using biplane imaging in single-vessel coronary interventional procedures.