Radiation-Induced Skin Injuries to Patients: What the Interventional Radiologist Needs to Know

Abstract

For a long time, radiation-induced skin injuries were only encountered in patients undergoing radiation therapy. In diagnostic radiology, radiation exposures of patients causing skin injuries were extremely rare. The introduction of fast multislice CT scanners and fluoroscopically guided interventions (FGI) changed the situation. Both methods carry the risk of excessive high doses to the skin of patients resulting in skin injuries. In the early nineties, several reports of epilation and skin injuries following CT brain perfusion studies were published. During the same time, several papers reported skin injuries following FGI, especially after percutaneous coronary interventions and neuroembolisations. Thus, CT and FGI are of major concern regarding radiation safety since both methods can apply doses to patients exceeding 5 Gy (National Council on Radiation Protection and Measurements threshold for substantial radiation dose level). This paper reviews the problem of skin injuries observed after FGI. Also, some practical advices are given how to effectively avoid skin injuries. In addition, guidelines are discussed how to deal with patients who were exposed to a potentially dangerous radiation skin dose during medically justified interventional procedures.

Fundamentals of Medical Radiation Safety: Focus on Reducing Short-Term and Long-Term Harmful Exposures

“…Radiation-induced gastrointestinal manifestations of ARaS manifest as nausea, vomiting, and bloody diarrhea. Severe dermatological injury with burns, desquamation, epilation, and ulceration can occur after significant radiation exposure even in the absence of ARaS [58], as exemplified by our clinical vignette #1. The above manifestations are summarized in Table 4.…”

Unintended and Accidental Exposures, Significant Dose Events and Trigger Levels in Interventional Radiology

“…• in procedures anticipated to be technically difficult, unusually prolonged, • in FGIs performed in the same region within the previous 3 months • in patients with increased radiosensitivity (especially due to younger age or genetic predisposition for details, see [17][18][19]) • where radiation therapy has been used or is planned for the same anatomic region.…”

“…Tissues at risk are the skin, hair and during neurointerventions the lenses of the eyes [17,20,21]. Stochastic effects are related to effective dose, for example, to the ovaries during pelvic embolization or the thyroid during interventions in the head and neck region.…”

Lesión cutánea por radiación en angioplastía coronaria compleja

“…Posterior se realizó predilatación con balón de 2.0 x 18 mm y 2.5 x 18mm, y finalmente implante de stent medicado a DA de 3.0 x 30 mm. Con apoyo de imagen Clear Stent se observó falta de expansión de stent en su segmento proximal por lo que se post dilató dicho segmento con balón NC 3.5 x ses 6 . Con este creciente número, la incidencia de LCR ha aumentado, estimada actualmente entre 1:10.000 a 1:100.000 procedimientos, pero el riesgo verdadero se desconoce 4 .…”