Radiation injury to skin following fluoroscopically guided procedures

Malkinson, Frederick D.

doi:10.1001/archderm.132.6.695

Cited by 9 publications

(8 citation statements)

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“…However, doses as high as 5 rad/min (0.5 Gy/min) have been documented. 19 As in the present case, most of the reported cases of FICRD are due to cardiac procedures. As summarized in the Table, our patient underwent 12 such procedures.…”

Section: Commentsupporting

confidence: 60%

Fluoroscopy-Induced Chronic Radiation Skin Injury

Frazier¹,

Richardson²,

Fabré³

et al. 2007

Arch Dermatol

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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.

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Section: Commentsupporting

confidence: 60%

Fluoroscopy-Induced Chronic Radiation Skin Injury

Frazier¹,

Richardson²,

Fabré³

et al. 2007

Arch Dermatol

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“…The authors estimated the average skin radiation exposure from these procedures to be as high as 2.5 Gy for cardiac catheterization and 6.4 Gy for coronary angioplasty [8,9].…”

Section: Radiation Doses During Coronary Interventionmentioning

confidence: 99%

“…Several studies have investigated the radiation doses received by doctors and patients during coronary angiography and angioplasty and the radiation risks encountered in such procedures [1][2][3][4][5][6][7][8][9]. Most of these studies were retrospective analyses; they have been conducted without the benefit of modern X-ray equipment and protection, and results have not been consistent.…”

Section: Introductionmentioning

confidence: 99%

“…Most of these studies were retrospective analyses; they have been conducted without the benefit of modern X-ray equipment and protection, and results have not been consistent. Recently, there has been serious concern in relation to the radiation injury to skin following prolonged catheterization procedures [8,9]. These important issues need clarification, particularly since most of the results available have been derived from studies conducted in the prestent era.…”

Section: Introductionmentioning

confidence: 99%

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Radiation exposure of patients and coronary arteries in the stent era: A prospective study

Katritsis

Efstathopoulos

Betsou

et al. 2000

Cathet. Cardiovasc. Intervent.

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Previous studies have investigated the radiation dose to doctors and patients during coronary angiography and angioplasty, but most of them were retrospective, conducted in the prestent era, and results have not been consistent. Effective dose of 57 patients undergoing coronary angiography and/or angioplasty was assessed by using a dose-area product (DAP) to effective dose conversion factor. Radiation exposure risks to patients were then calculated for each procedure. Thermoluminescent dosimeters, mounted on a specially designed catheter that was advanced to the left or right sinus of Valsalva, were used to measure the dose received by the coronary arteries. Mean effective dose received by patients were 5.0 +/- 0.5 mSv for coronary angiography, 6.6 +/- 1.0 mSv for angioplasty, 10.2 +/- 1.5 mSv for angioplasty followed by stent implantation, 13.6 +/- 2.5 mSv for angiography followed by ad hoc angioplasty, and 16.7 +/- 2.8 mSv for angiography followed by ad hoc angioplasty and stent implantation. Patient risk of developing cancer after each procedure was 0.025%, 0.033%, 0.051%, 0.068%, and 0.084%, respectively. Corresponding mean coronary irradiation doses were 24 +/- 2.5, 31.0 +/- 3.6, 43.6 +/- 7.2, 55.0 +/- 7.5, and 64.7 +/- 5.6 mGy, respectively. A linear relationship of the DAP and the dose at the coronary arteries was found: DAP = 1,273 (cm(2)) x coronary dose (mGy). Radiation exposure to coronary arteries and associated risk to patients are relatively low, even following complicated, multivessel angioplasty with stent implantation. Our method can be used for calculation of radiation risk to patients and radiation dose to coronary arteries by using external dosimeters. Cathet. Cardiovasc. Intervent. 51:259-264, 2000.

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“…To date, 9 cases of radiation dermatitis have been reported in the literature [4, 6, 8–12]. However, such extensive tissue necrosis has not been reported.…”

Section: Discussionmentioning

confidence: 99%

Thoracic Radionecrosis Following Repeated Cardiac Catheterization

Banič

Meier²,

Banič

et al. 2011

Radiology Research and Practice

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Radiodermatitis is a known complication in patients having undergone radiotherapy. It usually appears 2 to 5 years after irradiation. We are reporting on a case of radiodermatitis that occurred within months after coronary dilatation and stenting. It started with painful swelling, followed by a typical appearance on the skin surface. Histological finding confirmed the diagnosis. However, magnetic resonance imaging showed changes in the subcutaneous tissue extending into the ribs. A radical debridement was performed including removal of a partially necrotic 4th rib. The defect was closed with a latissimus dorsi transposition flap. Our findings are compared with the literature reports.

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Radiation injury to skin following fluoroscopically guided procedures

Cited by 9 publications

References 0 publications

Fluoroscopy-Induced Chronic Radiation Skin Injury

Fluoroscopy-Induced Chronic Radiation Skin Injury

Radiation exposure of patients and coronary arteries in the stent era: A prospective study

Thoracic Radionecrosis Following Repeated Cardiac Catheterization

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