Chronic radiodermatitis following cardiac catheterisation: a report of two cases and a brief review of the literature

Abstract

Cardiac angiography produces one of the highest radiation exposures of any commonly used diagnostic x ray procedure. Recently, serious radiation induced skin injuries have been reported after repeated therapeutic interventional procedures using prolonged fluoroscopic imaging. Two male patients, aged 62 and 71 years, in whom chronic radiodermatitis developed one to two years after two consecutive cardiac catheterisation procedures are reported. Both patients had undergone lengthy procedures using prolonged fluoroscopic guidance in a limited number of projections. The resulting skin lesions were preceded, in one case, by an acute erythema and took the form of a delayed pigmented telangiectatic, indurated, or ulcerated plaque in the upper back or below the axilla whose site corresponded to the location of the x ray tube during cardiac catheterisation. Cutaneous side eVects of radiation exposure result from direct damage to the irradiated tissue and have known thresholds. The diagnosis of radiation induced skin injury relies essentially on clinical and histopathological findings, location of skin lesions, and careful medical history. Interventional cardiologists should be aware of this complication, because chronic radiodermatitis may result in painful and resistant ulceration and eventually in squamous cell carcinoma. (Heart 1999;81:308-312)

Radiation dermatitis: Clinical presentation, pathophysiology, and treatment 2006

“…Serious radiationinduced skin injuries have been reported after unexpectedly high doses of kilovoltage irradiation exposure during fluoroscopic imaging, including cardiac catheterization. 4,5 Increasingly sophisticated therapeutic regimens and modern equipment have improved the delivery and ameliorated, but not eliminated, these adverse effects. Increased awareness of potential interactions between RT and concomitant chemotherapy has led to new treatment schedules designed to maximize antineoplastic effects while minimizing skin toxicity.…”

Fluoroscopy-Induced Chronic Radiation Skin Injury

“…These factors might also lead to underreporting, further contributing to the low prevalence of known cases of FICRD. 4 Even when radiation dermatitis is suspected, a lack of association between radiation injury and a fluoroscopic procedure leads to a denial of radiation exposure. Furthermore, many patients are unaware of what procedures they have undergone.…”

Does the use of additional X-ray beam filtration during cine acquisition reduce clinical image quality and effective dose in cardiac interventional imaging?

“…Moreover, with technological medical advances there is a tendency to undertake more complex interventions, increasing the duration of imaging in these cases. There are several reports in the literature of transient and permanent skin damage caused by cardiac catheterisation procedures [2][3][4][5][6][7][8][9], particularly with patients who require repeated coronary angiography procedures [10]. There is a need to reduce patient peak skin dose to a minimum level required for a given procedure in order to avoid these deterministic effects of radiation.…”