Intraoperative fluoroscopy allows real-time control of surgical procedures, permitting using minimally invasive techniques, with reduced anesthetic times. However, high exposure levels could be achieved, either in a single procedure or as a cumulative effect. So, special attention should be paid to intraoperative dosimetry, particularly in the very radiosensitive pediatric population (due to the high rate of cell division and life expectancy). Procedimental optimization and standardization of protective measures become essential.

The discrepancy in the techniques used, the different regions and anatomical differentiations in pediatrics, lead to very different patient exposures for the same procedure. Exposure to radiation during different surgical procedures using fluoroscopy is influenced by several factors including patient position, type and difficulty of the procedure, experience of the surgeon and radiographer.

The radiographer should adopt behaviors that allow optimization and standardization of pediatric imaging in intraoperative procedures and should use ALARA (as low as reasonably achievable) radiation doses. In particular, the shortest possible fluoroscopy time should be used, beam collimation should always be applied, in order to expose the smallest possible area, and doses should be adjusted to the child's weight and anatomical zone. The use of pulsed instead of continuous fluoroscopy, as well as of the lowest frame rate possible, is also essential, as well as reduction of the detector-structure distance and increase of the the x-ray source-structure distance. Fig1.

The objectives are to measure the radiation exposure in intraoperative fluoroscopy in pediatric patients at the Pediatric Hospital of Coimbra in the most common types of procedures. We have done this in order to raise awareness of the importance of dose reduction in these procedures. Moreover, we have listed some strategies to reduce the dose in fluoroscopy.