Radiation exposure benefit of a lead cap in invasive cardiology

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. Design: 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 cm(2). A 0.5 mm lead cap was effective in lowering measured levels to 1.8 (1.1) nSv/Gy x cm(2). Both devices together enabled attenuation to 0.5 (0.1) nSv/Gy x cm(2). The most advantageous line of vision for protection of the operator's eyes was >60degrees rightward. Conclusions: Use of 0.5 mm lead caps proved highly effective, attenuating S-ESAK-O to 2.7 (2.0)x10(-3) of baseline, and to 1.2 (1.4)x10(-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.