RAdiation exposure in Monoplane versus Biplane percutaneous cOronary angiography and interventions: The RAMBO Trial
David M. Leistner1; Lara S. Schlender1; Julia Steiner2; Aslihan Erbay2; Jens Klotsche3; Patrick Schauerte2; Arash Haghikia2; Ursula Rauch-Kröhnert2; David Sinning2; Alexander Lauten2; Hans-Christian Mochmann2; Carsten Skurk2; Ulf Landmesser1; Barbara E Stähli4,;
1. Department of Cardiology, Charité Berlin – University Medicine, Campus Benjamin Franklin, Berlin; and DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany 2. Department of Cardiology, Charité Berlin – University Medicine, Campus Benjamin Franklin, Berlin; and DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany 3. German Rheumatism Research Center Berlin; and Institute for Epidemiology and Health Care Economics, Charité Berlin – University Medicine, Campus Mitte, Berlin, Germany 4. Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin; and DZHK (German Centre for Cardiovascular Research) partner site Berlin, Berlin, Germany; Department of Cardiology, University Heart Centre, University Hospital Zurich, Zurich, Switzerland, Switzerland
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Aims: Interventional cardiologists are exposed to substantial occupational ionizing radiation. This study sought to investigate differences in radiation exposure in biplane versus monoplane coronary angiography and percutaneous coronary interventions (PCI).
Methods and Results: RAMBO (RAdiation exposure in Monoplane versus Biplane cOronary angiography and interventions) was a prospective, randomized, two-arm, single-centre, open-labelled trial, enrolling a total of 430 patients undergoing coronary angiography. Patients were randomly assigned to biplane or monoplane imaging. The primary efficacy measure, the operator radiation dose at the level of the left arm as measured by a wearable electronic dosimeter, was significantly higher in the biplane as compared with the monoplane group (4 [1-13] μSv versus 2 [0-6.8] μSv, p<0.001). The dose area product was 11955 [7095-18246] mGy*cm2 and 8349 [5851-14159] mGy*cm2 in the biplane and the monoplane groups (p<0.001). While fluoroscopy time did not differ among groups (p=0.89), the amount of contrast medium was lower with biplane as compared with monoplane imaging (p<0.001).
Conclusions: Biplane imaging for coronary angiography and PCI is related with an increased radiation exposure to the interventional cardiologist as compared with monoplane imaging. Monoplane imaging should be considered for advanced radioprotection in cardiac catheterization, with biplane imaging used for selected cases.