COMPARATIVE ANALYSIS OF RADIATION EXPOSURE IN BIPLANE VERSUS MONOPLANE CEREBRAL ANGIOGRAPHY: A SINGLE-CENTER RETROSPECTIVE STUDY

Ayyildiz H., KARABULUT M. M., Ersoy B., Barburoglu M.

JOURNAL OF ISTANBUL FACULTY OF MEDICINE-ISTANBUL TIP FAKULTESI DERGISI, vol.89, no.3, pp.199-204, 2026 (ESCI, Scopus, TRDizin)

Abstract

Objective: This study aimed to compare patient radiation exposure between biplane and monoplane digital subtraction angiography (DSA) systems during diagnostic cere bral angiography and evaluate the dose efficiency of modern dual plane technology. Materials and Methods: This retrospective single center study included 61 consecu tive patients who underwent diagnostic cerebral DSA between November 2021 and April 2022. Examinations were performed using a monoplane system (n=31) and a biplane system equipped with advanced dose reduction technology (n=30). For each procedure, total fluoroscopy time, fluoroscopy dose area product (DAP), exposure DAP, total DAP, and cumulative air kerma were recorded. Groups were compared using independent samples t tests or Mann-Whitney U tests, with p<0.05 considered statistically significant. Results: Fluoroscopy time was comparable between the monoplane and biplane groups (p=0.736). The biplane system produced a significantly greater number of image acquisitions (p<0.001) yet achieved markedly lower radiation doses. Median exposure DAP and total DAP were reduced by approximately 25-35%, and total air kerma was significantly lower in the biplane group (p<0.001). Fluoroscopy DAP was slightly higher for the biplane system (p=0.008), likely reflecting occasional dual plane use during complex catheter navigation. Conclusion: Despite acquiring more projections, the biplane DSA system demon strated substantially lower total radiation exposure than the monoplane system. These results indicate that modern biplane technology with advanced dose reduction algorithms (ClarityIQ) offers improved dose efficiency and enhanced patientsafety in diagnostic cerebral angiography. The observed reduction in radiation dose may reflect not only the biplane configuration itself but also differences in system generation, image processing algorithms, and acquisition protocols.