Fluoroscopically Guided Interventional Procedures: A Review of Radiation Effects on Patients’ Skin and Hair

Abstract

Most advice currently available with regard to fluoroscopic skin reactions is based on a table published in 1994. Many caveats in that report were not included in later reproductions, and subsequent research has yielded additional insights. This review is a consensus report of current scientific data. Expected skin reactions for an average patient are presented in tabular form as a function of peak skin dose and time after irradiation. The text and table indicate the variability of reactions in different patients. Images of injuries to skin and underlying tissues in patients and animals are provided and are categorized according to the National Cancer Institute skin toxicity scale, offering a basis for describing cutaneous radiation reactions in interventional fluoroscopy and quantifying their clinical severity. For a single procedure performed in most individuals, noticeable skin changes are observed approximately 1 month after a peak skin dose exceeding several grays. The degree of injury to skin and subcutaneous tissue increases with dose. Specialized wound care may be needed when irradiation exceeds 10 Gy. Residual effects from radiation therapy and from previous procedures influence the response of skin and subcutaneous tissues to subsequent procedures. Skin irradiated to a dose higher than 3-5 Gy often looks normal but reacts abnormally when irradiation is repeated. If the same area of skin is likely to be exposed to levels higher than a few grays, the effects of previous irradiation should be included when estimating the expected tissue reaction from the additional procedure.

Calculating the peak skin dose resulting from fluoroscopically guided interventions. Part I: Methods

“…The most recent report on radiation‐induced skin changes groups the changes into dose “bands” based on the PSD. ( 15 ) These bands are 0–2 Gy, 2–5 Gy, 5–10 Gy, 10–15 Gy, and greater than 15 Gy. Therefore, it is most important to accurately determine into which band a patient falls rather than to estimate the PSD with an accuracy of, for example, $\pm 10\%$.…”

Fluoroscopic Sentinel Events in Neuroendovascular Procedures: How to Screen, Prevent, and Address Occurrence

“…These include smoking, obesity, diabetes mellitus, connective tissue disorders (eg, rheumatoid arthritis, scleroderma), and certain chemotherapy agents. 9 Disorders resulting from defects in DNA repair genes can also predispose to radiation-induced skin injury. One such disorder of particular concern for the interventional neuroradiologist is ataxia-telangiectasia, in which the patient may need treatment for multiple cerebral or nasopharyngeal vascular malformations.…”

Staging of multivessel percutaneous coronary interventions: An expert consensus statement from the Society for Cardiovascular Angiography and Interventions

“…Interventionists should strive to minimize radiation doses during PCI [111][112][113][114] as outlined in Table IV. A radiation safety program that uses a qualified physicist, dosimetry monitoring, shielding, and training is essential [113].…”