title: Radiation exposure benefit of a lead cap in invasive cardiology.
abstract: BACKGROUND
  Occupational head exposure to radiation in cardiologists may cause radiation induced cataracts and an increased risk of brain cancer.
  
  
  OBJECTIVE
  To determine the effectiveness of 0.5 mm lead equivalent caps, not previously used in invasive cardiology, in comparison with a 1.0 mm lead equivalent ceiling mounted lead glass screen.
  
  
  METHODS
  An anthropomorphic Alderson-Rando phantom was used to represent the patient. Scatter entrance skin air kerma to the operator position (S-ESAK-O) was measured during fluoroscopy for all standard angulations and the S-ESAK-O per dose-area product (DAP) calculated, as applied to the phantom.
  
  
  RESULTS
  Measured mean (SD) left/right anterior oblique angulation ratios of S-ESAK-O without lead devices were 23.1 (10.1), and varied as a function of tube angulation, body height, and angle of incidence. S-ESAK-O/DAP decreased with incremental operator body height by 10 (3)% per 10 cm. A 1.0 mm lead glass shield reduced mean S-ESAK-O/DAP originating from coronary angiography from 1089 (764) to 54 (29) nSv/Gy x cm2. A 0.5 mm lead cap was effective in lowering measured levels to 1.8 (1.1) nSv/Gy x cm2. Both devices together enabled attenuation to 0.5 (0.1) nSv/Gy x cm2. The most advantageous line of vision for protection of the operator's eyes was > or = 60 degrees rightward.
  
  
  CONCLUSIONS
  Use of 0.5 mm lead caps proved highly effective, attenuating S-ESAK-O to 2.7 (2.0) x 10(-3) of baseline, and to 1.2 (1.4) x 10(-3) of baseline where there was an additional 1.0 mm lead glass shield. These results could vary according to the x ray systems used, catheterisation protocols, and correct use of radiation protection devices.
authors.affiliation: Department of Cardiology, Klinik Fraenkische Schweiz, Ebermannstadt, Germany. eberhard.kuon@klinik-fraenkische-schweiz.de
authors.forename: E
authors.initials: E
authors.lastname: Kuon
authors.forename: J
authors.initials: J
authors.lastname: Birkel
authors.forename: M
authors.initials: M
authors.lastname: Schmitt
authors.forename: J B
authors.initials: JB
authors.lastname: Dahm
mesh_terms: D002309:Cardiology; D005471:Fluoroscopy; D006257:Head; D006801:Humans; D007854:Lead; D016273:Occupational Exposure / Q000009:adverse effects / Q000517:prevention & control*; D019047:Phantoms, Imaging; D011481:Protective Clothing; D011829:Radiation Dosage; D011835:Radiation Protection / Q000295:instrumentation*; D015641:Radiography, Interventional / Q000009:adverse effects; D012542:Scattering, Radiation
chemical_list: D007854:Lead