Skin injury is a deterministic effect of radiation. Once a threshold dose has been exceeded, the severity of the radiation effect at any point on the skin increases with increasing dose. Peak skin dose is defined as the highest dose delivered to any portion of the patient's skin. Reducing peak skin dose can reduce the likelihood and type of skin injury. Unfortunately, peak skin dose is difficult to measure in real time, and most currently available fluoroscopic systems do not provide the operator with sufficient information to minimize skin dose. Measures that reduce total radiation dose will reduce peak skin dose, as well as dose to the operator and assistants. These measures include minimizing fluoroscopy time, the number of images obtained, and dose by controlling technical factors. Specific techniques-dose spreading and collimation-reduce both peak skin dose and the size of skin area subjected to peak skin dose. For optimum effect, real-time knowledge of skin-dose distribution is invaluable. A trained operator using well-maintained state-of-the art equipment can minimize peak skin dose in all fluoroscopically guided procedures.