title: Randomized Controlled Trial of Radiation Protection With a Patient Lead Shield and a Novel, Nonlead Surgical Cap for Operators Performing Coronary Angiography or Intervention.
abstract: BACKGROUND
  Interventional cardiologists receive one of the highest levels of annual occupational radiation exposure. Further measures to protect healthcare workers are needed.
  
  
  RESULTS
  We evaluated the efficacy of a pelvic lead shield and a novel surgical cap in reducing operators' radiation exposure. Patients undergoing coronary angiography or percutaneous coronary intervention (n=230) were randomized to have their procedure with or without a lead shield (Ultraray Medical, Oakville, Canada) placed over the patient. During all procedures, operators wore the No Brainer surgical cap (Worldwide Innovations and Technology, Kansas City, KS) designed to protect the head from radiation exposure. The coprimary outcomes for the lead shield comparison were (1) operator dose (µSv) and (2) operator dose indexed for air kerma (µSv/mGy). For the cap comparison, the primary outcome was the difference between total radiation dose (µSv; internal and external to cap). The lead shield use resulted in a 76% reduction in operator dose (mean dose, 3.07; 95% confidence interval [CI], 2.00-4.71 µSv lead shield group versus 12.57; 95% CI, 8.14-19.40 µSv control group; P<0.001). The mean dose indexed for air kerma was reduced by 72% (0.004; 95% CI, 0.003-0.005 µSv/mGy lead shield group versus 0.015; 95% CI, 0.012-0.019 µSv/mGy control group; P<0.001). The cap use resulted in a significant reduction in operator head radiation exposure (mean left temporal difference [external-internal] radiation dose was 4.79 [95% CI, 3.30-6.68] µSv; P<0.001).
  
  
  CONCLUSIONS
  The use of a pelvic lead shield and the cap reduced significantly the operator radiation exposure and can be easily incorporated into clinical practice.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT02128035.
authors.affiliation: From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.).
authors.forename: Ashraf
authors.initials: A
authors.lastname: Alazzoni
authors.affiliation: From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.).
authors.forename: Chris L
authors.initials: CL
authors.lastname: Gordon
authors.affiliation: From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.).
authors.forename: Jaffer
authors.initials: J
authors.lastname: Syed
authors.affiliation: From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.).
authors.forename: Madhu K
authors.initials: MK
authors.lastname: Natarajan
authors.affiliation: From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.).
authors.forename: Michael
authors.initials: M
authors.lastname: Rokoss
authors.affiliation: From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.).
authors.forename: Jon-David
authors.initials: JD
authors.lastname: Schwalm
authors.affiliation: From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.).
authors.forename: Shamir R
authors.initials: SR
authors.lastname: Mehta
authors.affiliation: From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.).
authors.forename: Tej
authors.initials: T
authors.lastname: Sheth
authors.affiliation: From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.).
authors.forename: Nicholas
authors.initials: N
authors.lastname: Valettas
authors.affiliation: From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.).
authors.forename: James
authors.initials: J
authors.lastname: Velianou
authors.affiliation: From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.).
authors.forename: Shaheen
authors.initials: S
authors.lastname: Pandie
authors.affiliation: From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.).
authors.forename: Darar
authors.initials: D
authors.lastname: Al Khdair
authors.affiliation: From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.).
authors.forename: Michael
authors.initials: M
authors.lastname: Tsang
authors.affiliation: From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.).
authors.forename: Brandi
authors.initials: B
authors.lastname: Meeks
authors.affiliation: From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.).
authors.forename: Kiersten
authors.initials: K
authors.lastname: Colbran
authors.affiliation: From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.).
authors.forename: Ed
authors.initials: E
authors.lastname: Waller
authors.affiliation: From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.).
authors.forename: Shun
authors.initials: S
authors.lastname: Fu Lee
authors.affiliation: From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.).
authors.forename: Tamara
authors.initials: T
authors.lastname: Marsden
authors.affiliation: From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.). sanjit.jolly@phri.ca.
authors.forename: Sanjit S
authors.initials: SS
authors.lastname: Jolly
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D007854:Lead; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000517:prevention & control*; D016272:Occupational Health; D062645:Percutaneous Coronary Intervention; D011481:Protective Clothing; D000069079:Radiation Exposure / Q000517:prevention & control*; D011835:Radiation Protection / Q000295:instrumentation*
chemical_list: D007854:Lead
keywords: cardiology; coronary angiography; coronary angioplasty; percutaneous coronary intervention; radiation