Smith Keith, Crowhurst James, Walters Darren, Starkey Deborah
1 Medical Imaging Department, The Prince Charles Hospital , Chermside , Queensland, Australia.
2 Cardiology Department, The Prince Charles Hospital, Rode Road , Chermside , Queensland, Australia.
Br J Radiol. 2019 Jan;92(1093):20180367. doi: 10.1259/bjr.20180367. Epub 2018 Sep 21.
: This study compares the performance of bi-plane coronary angiography against single plane angiography in terms of the volume of contrast used (ml) and the total dose-area product (DAP) (μGym) to the patient measured directly via flat panel detectors.
: A total of 5176 adult diagnostic cardiac angiograms from a hospital in Brisbane, Australia were retrospectively studied. Patients with aortograms, iliac or femoral artery imaging, and stenting or graft interventions were excluded. Student's t-tests were used to compare means, and confounding variables were compared using multivariate regression. This quantified the effects of bi-plane system use holding constant other factors (e.g.) body mass index (BMI), age, room, sex, number of digital acquisitions and fluoro time.
: Bi-plane imaging had an average difference in mean contrast use of -15.1 ml [15.5% 95% confidence interval (CI) (-13.2, -17.0) p<0.001], multivariate regression demonstrated a -27.0 ml reduction in contrast use [28% 95% CI (-29.0, -24.83) p<0.0001] when the significant effects of fluoro time, number of digital acquisitions, BMI and sex were held constant. Bi-plane imaging had an average difference in mean DAP of + 887.1 μGym [23% 95% CI (+1110.7, +663.4) p < 0.001], whilst multivariate regression found a +628.3 Gym increase in DAP [16% 95% CI (+467.5, +789.3) p<0.001] when the significant effects of fluoro time, number of digital acquisitions, BMI and sex were held constant.
: These results demonstrate that bi-plane imaging uses less contrast media than single-plane imaging for coronary angiography at the expense of more radiation. Bi-plane imaging may be preferable in patients with renal impairment, however single plane imaging may be preferable in those without renal impairment.
: This is a large cohort and statistically comprehensive study comparing bi-plane and single plane coronary angiography. Other studies 4, 5, 6, 12 have used Student's t-tests to measure the difference between means, however this provides no causative information on the differences found. This study provides a view of the causative impact of bi-plane usage on DAP and contrast use via multivariate regression modelling.
本研究比较双平面冠状动脉造影与单平面冠状动脉造影在造影剂用量（毫升）和直接通过平板探测器测量的患者总剂量面积乘积（DAP）（微戈瑞·米）方面的表现。
对澳大利亚布里斯班一家医院的5176例成人诊断性心脏血管造影进行回顾性研究。排除进行主动脉造影、髂动脉或股动脉成像以及支架置入或移植干预的患者。采用学生t检验比较均值，并使用多元回归比较混杂变量。这量化了在保持其他因素（如体重指数（BMI）、年龄、房间、性别、数字采集数量和透视时间）不变的情况下使用双平面系统的影响。
双平面成像在平均造影剂用量方面的平均差异为-15.1毫升[15.5% 95%置信区间（CI）（-13.2，-17.0），p<0.001]，当透视时间、数字采集数量、BMI和性别的显著影响保持不变时，多元回归显示造影剂用量减少27.0毫升[28% 95% CI（-29.0，-24.83），p<0.0001]。双平面成像在平均DAP方面的平均差异为+887.1微戈瑞·米[23% 95% CI（+1110.7，+663.4），p<0.001]，而多元回归发现当透视时间、数字采集数量、BMI和性别的显著影响保持不变时，DAP增加628.3戈瑞·米[16% 95% CI（+467.5，+789.3），p<0.001]。
这些结果表明，双平面成像在冠状动脉造影中使用的造影剂比单平面成像少，但代价是辐射更多。双平面成像可能更适合肾功能不全的患者，然而单平面成像可能更适合无肾功能不全的患者。
这是一项比较双平面和单平面冠状动脉造影的大型队列且统计全面的研究。其他研究4、5、6、12使用学生t检验来测量均值之间的差异，然而这并未提供关于所发现差异的因果信息。本研究通过多元回归建模提供了双平面使用对DAP和造影剂用量的因果影响视图。
