BACKGROUND: Radiographically guided investigations may be associated with excessive radiation exposure, which may cause skin injuries. The purpose of this study was to develop and test a system that measures in real time the dose applied to each 1-cm(2) area of skin, taking into account the movement of the x-ray source and changes in the beam characteristics. The goal of such a system is to help prevent high doses that might cause skin injury. METHODS AND RESULTS: The entrance point, beam size, and dose at the skin of the patient were calculated by use of the geometrical settings of gantry, investigation table, and x-ray beam and an ionization chamber. The data are displayed graphically. Three hundred twenty-two sequential cardiac investigations in adult patients were analyzed. The mean peak entrance dose per investigation was 0.475 Gy to a mean skin area of 8.2 cm(2). The cumulative KERMA-area product per investigation was 52.2 Gy/cm(2) (25.4 to 99.2 Gy/cm(2)), and the mean entrance beam size at the skin was 49.2 cm(2). Twenty-eight percent of the patients (90/322) received a maximum dose of <1 Gy to a small skin area ( approximately 6 cm(2)), and 13.5% of the patients (42/322) received a maximum dose of >2 Gy. CONCLUSIONS: Monitoring of the dose distribution at the skin will alert the operator to the development of high-dose areas; by use of other gantry settings with nonoverlapping entrance fields, different generator settings, and extra collimation, skin lesion can be avoided.

*Computer Systems/standards, Adult, Aged, Coronary Angiography/adverse effects/methods/*standards, Feasibility Studies, Female, Humans, Male, Middle aged, Radiation Dosage, Radiation Injuries/*prevention & control, Radiometry/instrumentation/*methods, Reproducibility of Results, Skin/*radiation effects/radiography, Time Factors, X-Rays/adverse effects
Circulation (Baltimore)
Erasmus MC: University Medical Center Rotterdam

de Feijter, P.J, Serruys, P.W.J.C, Roelandt, J.R.T.C, & den Boer, A. (2001). Real-time quantification and display of skin radiation during coronary angiography and intervention. Circulation (Baltimore), 104(15), 1779–1784. Retrieved from