title: Invasive Cardiologists Are Exposed to Greater Left Sided Cranial Radiation: The BRAIN Study (Brain Radiation Exposure and Attenuation During Invasive Cardiology Procedures).
abstract: OBJECTIVE
  This study sought to determine radiation exposure across the cranium of cardiologists and the protective ability of a nonlead, XPF (barium sulfate/bismuth oxide) layered cap (BLOXR, Salt Lake City, Utah) during fluoroscopically guided, invasive cardiovascular (CV) procedures.
  
  
  BACKGROUND
  Cranial radiation exposure and potential for protection during contemporary invasive CV procedures is unclear.
  
  
  METHODS
  Invasive cardiologists wore an XPF cap with radiation attenuation ability. Six dosimeters were fixed across the outside and inside of the cap (left, center, and right), and 3 dosimeters were placed outside the catheterization lab to measure ambient exposure.
  
  
  RESULTS
  Seven cardiology fellows and 4 attending physicians (38.4 ± 7.2 years of age; all male) performed diagnostic and interventional CV procedures (n = 66.2 ± 27 cases/operator; fluoroscopy time: 14.9 ± 5.0 min). There was significantly greater total radiation exposure at the outside left and outside center (106.1 ± 33.6 mrad and 83.1 ± 18.9 mrad) versus outside right (50.2 ± 16.2 mrad; p < 0.001 for both) locations of the cranium. The XPF cap attenuated radiation exposure (42.3 ± 3.5 mrad, 42.0 ± 3.0 mrad, and 41.8 ± 2.9 mrad at the inside left, inside center, and inside right locations, respectively) to a level slightly higher than that of the ambient control (38.3 ± 1.2 mrad, p = 0.046). After subtracting ambient radiation, exposure at the outside left was 16 times higher than the inside left (p < 0.001) and 4.7 times higher than the outside right (p < 0.001). Exposure at the outside center location was 11 times higher than the inside center (p < 0.001), whereas no difference was observed on the right side.
  
  
  CONCLUSIONS
  Radiation exposure to invasive cardiologists is significantly higher on the left and center compared with the right side of the cranium. Exposure may be reduced similar to an ambient control level by wearing a nonlead XPF cap. (Brain Radiation Exposure and Attenuation During Invasive Cardiology Procedures [BRAIN]; NCT01910272).
authors: Division of Cardiovascular Medicine, University of California, San Diego Sulpizio Cardiovascular Center, La Jolla, California.
authors: Ryan R
authors: RR
authors: Reeves
authors: Division of Cardiovascular Medicine, University of California, San Diego Sulpizio Cardiovascular Center, La Jolla, California.
authors: Lawrence
authors: L
authors: Ang
authors: Division of Cardiovascular Medicine, University of California, San Diego Sulpizio Cardiovascular Center, La Jolla, California.
authors: John
authors: J
authors: Bahadorani
authors: Division of Cardiovascular Medicine, University of California, San Diego Sulpizio Cardiovascular Center, La Jolla, California.
authors: Jesse
authors: J
authors: Naghi
authors: Division of Cardiovascular Medicine, University of California, San Diego Sulpizio Cardiovascular Center, La Jolla, California.
authors: Arturo
authors: A
authors: Dominguez
authors: Division of Cardiovascular Medicine, University of California, San Diego Sulpizio Cardiovascular Center, La Jolla, California.
authors: Vachaspathi
authors: V
authors: Palakodeti
authors: Division of Cardiovascular Medicine, University of California, San Diego Sulpizio Cardiovascular Center, La Jolla, California.
authors: Sotirios
authors: S
authors: Tsimikas
authors: Division of Cardiovascular Medicine, University of California, San Diego Sulpizio Cardiovascular Center, La Jolla, California.
authors: Mitul P
authors: MP
authors: Patel
authors: Division of Cardiovascular Medicine, University of California, San Diego Sulpizio Cardiovascular Center, La Jolla, California. Electronic address: emahmud@ucsd.edu.
authors: Ehtisham
authors: E
authors: Mahmud
mesh_terms: D000328:Adult; D001466:Barium Sulfate; D001729:Bismuth; D001921:Brain / Q000528:radiation effects*; D006328:Cardiac Catheterization / Q000009:adverse effects*; D004867:Equipment Design; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects / Q000517:prevention & control*; D011446:Prospective Studies; D011481:Protective Clothing; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000009:adverse effects / Q000517:prevention & control*; D015641:Radiography, Interventional / Q000009:adverse effects*; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D001466:Barium Sulfate; C033301:bismuth oxide; D001729:Bismuth
keywords: fellow; fluoroscopy; invasive cardiology; radiation exposure