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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;
    eberhard.kuon{at}klinik-fraenkische-schweiz.de

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.

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

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