Fluoroscopy-Induced Skin Necrosis

Liu, Jin; Hoss, Diane M.; Phillips, Tania J.

doi:10.1001/archderm.139.2.140

Cited by 16 publications

(13 citation statements)

References 13 publications

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“…However, without clear evidence of radiation exposure, FICRD is often misdiagnosed. 5 Complicating the diagnosis is the insidious and variable onset of symptoms ranging from erythema to dermal necrosis. 2 Diagnosing FICRD is established by correlating a patient history of a fluoroscopy-guided procedure to a skin lesion with the appropriate cutaneous characteristics located at the entrance site of ionizing radiation for that particular procedure.…”

Section: Commentmentioning

confidence: 99%

“…The machinery used, the particular facility, and most importantly the proficiency of the person performing the procedure (a 6-fold variance) all play a role in determining the dose of radiation for a given procedure. 5 Finally, patients requiring cardiac catheterizations and percutaneous transluminal coronary angioplasty procedures often undergo multiple exposures, easily putting them at risk for exposure to the cumulative threshold dose required for FICRD (1000 rad [10 Gy]). 2 While certain changes have been made to limit skin exposure during fluoroscopy, radiation exposure during fluoroscopic procedures remains a risk to patients.…”

Section: Commentmentioning

confidence: 99%

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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: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Fluoroscopy-Induced Chronic Radiation Skin Injury

Frazier¹,

Richardson²,

Fabré³

et al. 2007

Arch Dermatol

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“…These minimally invasive procedures are often the treatment of choice for serious, life-threatening conditions and involve a relatively high amount of radiation exposure to a single localized area for a prolonged time, ranging from 30 min to 1 h [3]. …”

Section: Discussionmentioning

confidence: 99%

“…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).…”

Section: Discussionmentioning

confidence: 99%

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

2012

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Fluoroscopy-induced chronic radiation dermatitis resulting from prolonged exposure to ionizing radiation during interventional procedures has been documented in the medical literature. However, this condition often requires a high clinical suspicion in order to establish a correct diagnosis. In this report, the development of deep scalp ulceration with bone exposure following the endovascular coiling of an anterior communicating artery aneurysm 8 years before is described. A skin biopsy specimen demonstrated changes consistent with chronic radiation dermatitis and ruled out malignancy. This case report expands the clinical manifestation spectrum of fluoroscopy-induced chronic radiation skin injury and highlights the importance of recognizing these lesions early to prevent morbidity related to radiation-induced skin damage.

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Davies

Gislason‐Lee

Cowen

et al. 2014

Radiation Protection Dosimetry

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The impact of spectral filtration in digital ("cine") acquisition was investigated using a flat panel cardiac interventional X-ray imaging system. A 0.1 mm Cu and 1.0 mm Al filter added to the standard acquisition mode created the filtered mode for comparison. Image sequences of 35 patients were acquired; a double blind subjective image quality assessment was completed and dose area product (DAP) rates were calculated. Entrance surface dose (ESD) and effective dose (E) rates were determined for 20 and 30 cm phantoms. Phantom ESD fell by 28% and 41% and E by 1% and 0.7 %, for the 20 and 30 cm phantoms respectively when using the filtration. Patient DAP rates fell by 43% with no statistically significant difference in clinical image quality. Adding 0.1 mm Cu and 1.0 mm Al filtration in acquisition substantially reduces patient ESD and DAP, with no significant change in E or clinical image quality.

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Fluoroscopy-Induced Skin Necrosis

Cited by 16 publications

References 13 publications

Fluoroscopy-Induced Chronic Radiation Skin Injury

Fluoroscopy-Induced Chronic Radiation Skin Injury

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

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

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