Article Text

Download PDFPDF
Radiation exposure benefit of a lead cap in invasive cardiology
  1. E Kuon1,
  2. J Birkel1,
  3. M Schmitt1,
  4. J B Dahm2
  1. 1Department of Cardiology, Klinik Fraenkische Schweiz, Ebermannstadt, Germany
  2. 2Department of Internal Medicine, Ernst Moritz Arndt University, Greifswald, Germany
  1. Correspondence to:
    Dr Eberhard Kuon, Klinik Fraenkische Schweiz, Feuersteinstr 2, D-91320 Ebermannstadt, Germany;


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 × cm2. A 0.5 mm lead cap was effective in lowering measured levels to 1.8 (1.1) nSv/Gy × cm2. Both devices together enabled attenuation to 0.5 (0.1) nSv/Gy × cm2. The most advantageous line of vision for protection of the operator’s eyes was ⩾ 60° rightward.

Conclusions: Use of 0.5 mm lead caps proved highly effective, attenuating S-ESAK-O to 2.7 (2.0) × 10−3 of baseline, and to 1.2 (1.4) × 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.

  • dosimetry
  • radiation safety
  • radiation exposure
  • DAP, dose–area product
  • ESAK, entrance skin air kerma
  • ESD, entrance skin dose
  • LAO, left anterior oblique
  • PA, posterior-anterior
  • RAO, right anterior oblique
  • S-ESAK-O, scatter entrance skin air kerma to the operator position

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.