Recommended guidelines for choosing and optimizing surgical C-arms in pediatric surgery to minimize radiation exposure

Surgical C-arms are essential tools in pediatric surgery in various specialties. The selection of an appropriate C-arm for pediatric use is critical, as manufacturers offer different balances between radiation dose and image quality. This study introduces a practical measurement protocol that enables straightforward comparison of C-arms using readily available tools in most facilities. A measurement protocol for evaluating radiation dose and image quality across different C-arm models for pediatric use is suggested. To illustrate this methodology, seven C-arm models from three manufacturers were assessed using a polymethyl methacrylate phantom to simulate pediatric patients. Dose and image quality were measured across various configurations, including fluoroscopy and low-dose modes, while considering features like additional copper filtration, anti-scatter grid removal, and field zoom. Dose and image quality measurements on C-arms illustrate the methodology's application and the impact of fluoroscopy parameters and pediatric-specific features on dose and image quality. Recommendations are provided to guide the selection and optimization of C-arms for pediatric surgery, ensuring the best compromise between dose reduction and diagnostic image quality. This study introduces a practical method for evaluating C-arms in pediatric settings, helping to improve equipment selection and optimize imaging protocols for safer pediatric imaging practices.