SU‐E‐I‐24: How Does C‐Arm Rotation Affect Peak Skin Dose in Interventional Cardiology?

Purpose: Rotating the C‐arm during an interventional cardiology (IC) procedure is believed to spread radiation dose on the skin. Previous studies have shown that this practice often increases peak skin dose (PSD) in interventional radiology (IR) procedures. We sought to determine whether C‐arm rotation reduces the PSD in IC procedures and, if so, under what circumstances. Methods: Simulations were performed using a numerical ray‐tracing algorithm to analyze the effect of C‐arm rotation on PSD across a range of patient sizes, C‐arm configurations, and procedure types. Specific data on modern fluoroscopes and patient dimensions were used as inputs to the simulations. Conclusion: In many cases, modest angles completely eliminated overlap between x‐ray field sites on the skin. C‐arm rotation was most effective for large patients and small x‐ray field sizes. In cases in which overlap remained, PSD increases were generally small, and the 95% area load was reduced. One exception was craniocaudal rotation, which tended to increase PSD, substantially in some cases. The use of a prophylactic approach in which the C‐arm was rotated between small opposing left and right anterior oblique angles was effective in dividing the skin dose between two distinct skin sites. Conclusions: Rotating the C‐arm reduces PSD in IC procedures when used as either a procedural modification or a prophylactic dose reduction strategy. Tight collimation increases the benefit of C‐arm rotation. Conflict of Interest: A. S. Pasciak and A. K. Jones are founders of Fluoroscopic Safety, LLC. Fluoroscopic Safety, LLC provides educational instruction on the safe use of fluoroscopy to physicians.