The objectives of this study were to disclose and to reduce occupational radiation leakage in invasive cardiology. Prospectively, we analyzed various dose parameters for 330 coronary procedures. We used a Rando phantom to measure scatter entrance skin air kerma to the operator (S-ESAK-O) during fluoroscopy for all standard tube angulations, and to plot isodose lines for 0 degrees /0 degrees -posterior anterior angulation. The patient's measured dose area product due to diagnostic catheterization and elective percutaneous transluminal coronary angioplasty was 6.2 and 10.4 Gycm(2), which represents 11% and 13% of currently typical values, respectively. With use of 0.5- and 1.0-mm overcouch and undercouch shielding, it was possible to reduce the mean of 4,686 nSv/Gycm(2) to 677 and 277 nSv/Gycm(2), respectively. Closure of radiation leakage up to 897 microSv/hour at the operator's gonadal height (80 to 105 cm), not heretofore described, was achieved by an additional 1.0-mm, lead-equivalent undercouch-top and overcouch-flap adjacent to the table, down to a S-ESAK-O/dose area product level of 47.5 nSv/Gycm(2). With use of a 0.5-mm lead apron, collar, glasses, foot-switch shield and 1.0-mm lead cover around the patient's thighs, the operator received a mean S-ESAK-O of 8.5, while his forehead, eyes, thyroid, chest, gonads, and hands were exposed to 68.2, 1.2, 1.2, 1.2, 0.8, and 58.2 nSv/Gycm(2), respectively. In conclusion, radiation-attenuating intervention techniques and improved lead protection can effectively contribute to a new state of the art in invasive cardiology, with reduction of operator radiation exposure to 0.8% of typical S-ESAK-O levels in advanced catheterization laboratories.