Fluoroscopy-Induced Chronic Radiation Skin Injury

Abstract

Background: Fluoroscopy-induced chronic radiation dermatitis (FICRD) resulting from prolonged exposure to ionizing radiation during interventional procedures has been documented in the radiology and cardiology literature. However, the phenomenon has been rarely reported in the dermatologic literature. Since patients with FICRD often see a dermatologist or a primary care physician to treat their injuries, the diagnosis of FICRD is perhaps often overlooked.Observations: A 62-year-old man with type 2 diabetes mellitus and severe coronary artery disease was seen with a 2-year history of a pruritic, tender, telangiectatic patch lesion over his left scapula. Over the next 2 years, the lesion became indurated and eventually ulcerated. A skin biopsy specimen demonstrated changes consistent with a chronic radiation dermatitis. The patient was unaware of radiation exposure, but persistent questioning from his dermatologists revealed that he had undergone multiple fluoroscopy-guided cardiac procedures. This was confirmed by a review of his medical records. Conclusion:The diagnosis of FICRD should be considered for any patient who is seen with an acquired vascular lesion, a morphealike lesion, or an unexplained ulcer localized over the scapula, the back, or lateral trunk below the axilla.

Impact of latest generation cardiac interventional X-ray equipment on patient image quality and radiation dose for trans-catheter aortic valve implantations

“…4 Two types of biological damage may occur from radiation exposure. Deterministic effects include anatomic damage known to occur when radiation dose exceeds a specific amount, such as skin burns and hair loss on patients undergoing cardiac interventional procedures [5][6][7] and cataracts to the eye lens on interventional cardiologists; 8 recently, the cataracts threshold dose was reduced by 75%, 9 prompting efforts to reduce radiation doses to the eye. 10 Stochastic effects, including damage to the DNA which may cause long-term genetic defects and cancers, increase with radiation exposure; there is no specific threshold dose and risk is cumulative, so several decades may pass before manifestation.…”

Chronic Scalp Ulceration as a Late Complication of Fluoroscopically Guided Cerebral Aneurysm Embolization

“…The most common entrance sites of ionizing radiation associated with cardiac procedures are the scapula, back and lateral trunk under the axilla. Other common locations are the left flank (associated with mesenteric artery angiography and stent placement), the back (associated with TIPS) and the temporoparietal and occipital areas of the scalp (associated with neurovascular embolization) [1,2,5,6,7,8,9,10,11,12,13,14,15]. For most patients, clinically significant skin and hair reactions are thought to occur when the skin dose is >5 Gy.…”

“…In particular, severe skin injury with secondary ulceration has been reported in the literature to date in relation to percutaneous transluminal coronary angioplasty with or without stent placement, electrophysiology ablative procedures for cardiac arrhythmias, TIPS, mesenteric artery angiography with stent placement and renal artery catheterization and angioplasty [2,3,4,5,17]. Nevertheless, to our knowledge, no cases of skin necrosis with secondary ulceration related to endovascular intervention for cerebral aneurysms have yet been reported (table 2).…”

Comprehensive assessment of patient image quality and radiation dose in latest generation cardiac x-ray equipment for percutaneous coronary interventions

“…2 Deterministic effects occur from radiation doses exceeding a threshold; these include skin burns and hair loss among patients (threshold absorbed dose of 2 Gy) [3][4][5][6] and cataracts to the eye lens of interventional cardiologists (occupational threshold dose of 20 mSv∕year). [7][8][9] Stochastic effects, with no specific threshold dose, 10 result from damaged DNA, causing long-term genetic defects and cancers; this is generally more of a concern for pediatric than adult patients.…”