title: C-arm rotation as a method for reducing peak skin dose in interventional cardiology.
abstract: Prolonged interventional cardiology (IC) procedures may result in radiation-induced skin injury, a potentially preventable cause of patient morbidity. Rotating the C-arm during an IC procedure may reduce this risk, although the methods by which the technique can be practically applied remains unexplored. A previous study demonstrated that C-arm rotation often increases peak skin dose (PSD) in interventional radiology procedures. The purpose of this study was to determine whether C-arm rotation reduces the PSD in IC procedures and, if so, under what circumstances.
  
  
  
  Simulations were performed using a numerical ray-tracing algorithm to analyse the effect of C-arm rotation on PSD across a range of patient sizes, C-arm configurations and procedure types. Specific data from modern fluoroscopes and patient dimensions were used as inputs to the simulations.
  
  
  
  In many cases, modest C-arm rotation angles completely eliminated overlap between X-ray field sites on the skin. When overlap remained, PSD increases were generally small. One exception was craniocaudal rotation, which tended to increase PSD. C-arm rotation was most effective for large patients and small X-ray field sizes. Small patients may not benefit from C-arm rotation as a procedural modification. The use of a prophylactic method where the C-arm was rotated between small opposing oblique angles was effective in reducing PSD.
  
  
  
  With the exception of rotation to steep craniocaudal angles, rotating the C-arm reduces PSD in IC procedures when used as either a procedural modification or a prophylactic strategy. Tight collimation increases the benefit of C-arm rotation.
authors.affiliation: Department of Radiology, University of Tennessee Medical Center, Knoxville, Tennessee , USA.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Pasciak
authors.affiliation: Department of Radiology, University of Tennessee Medical Center, Knoxville, Tennessee , USA.
authors.forename: Austin C
authors.initials: AC
authors.lastname: Bourgeois
authors.affiliation: Department of Imaging Physics, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA.
authors.forename: A Kyle
authors.initials: AK
authors.lastname: Jones
keywords: INTERVENTIONAL CARDIOLOGY; cardiac catheterization; dose reduction; fluoroscopy; radiation dose