Subacute radiation dermatitis from fluoroscopy during coronary artery stenting: Evidence for cytotoxic lymphocyte mediated apoptosis

Stone, Mary Seabury; Robson, Kristi J.; LeBoit, Philip E.

doi:10.1016/s0190-9622(98)70577-8

Cited by 42 publications

(24 citation statements)

References 8 publications

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“…Subacute radiation injury is a mixture of these clinical signs, and the diagnosis is based on the key histopathologic feature: lichenoid tissue reaction. 6 To our knowledge, 42 cases of fluoroscopic-induced radiation skin injury have been reported in the dermatology literature. Of these 42 cases, 31 were defined as chronic radiation dermatitis (FICRD), 2,5-14 3 were subacute (1 of which developed into chronic disease), 6,15 and 9 were acute dermatitis.…”

Section: Commentmentioning

confidence: 99%

“…6 To our knowledge, 42 cases of fluoroscopic-induced radiation skin injury have been reported in the dermatology literature. Of these 42 cases, 31 were defined as chronic radiation dermatitis (FICRD), 2,5-14 3 were subacute (1 of which developed into chronic disease), 6,15 and 9 were acute dermatitis. [16][17][18] There are a number of fluoroscopic procedures implicated as causative mechanisms for radiation injury.…”

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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“…The growing use of interventional cardiology (IC) procedures, while offering enormous benefits to patients, also contributes significantly to the radiation exposure of patients and personnel [1,2,3,4,5,6,7,8,9,10]. The IC procedures have been known to require radiation doses that in some instances have resulted in deterministic skin injuries to the patient [7,8,9,10,11,12,13,14].…”

Section: Introductionmentioning

confidence: 99%

“…The IC procedures have been known to require radiation doses that in some instances have resulted in deterministic skin injuries to the patient [7,8,9,10,11,12,13,14].…”

Section: Introductionmentioning

confidence: 99%

Preliminary reference levels in interventional cardiology

et al. 2003

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This article describes the European DIMOND approach to defining reference levels (RLs) for radiation doses delivered to patients during two types of invasive cardiology procedures, namely coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA). Representative centres of six European countries recorded patients' doses in terms of dose-area product (DAP), fluoroscopy time and number of radiographic exposures, using X-ray equipment that has been subject to constancy testing. In addition, a DAP trigger level for cardiac procedures which should alert the operator to possible skin injury, was set to 300 Gyxcm2. The estimation of maximum skin dose was recommended in the event that a DAP trigger level was likely to be exceeded. The proposed RLs for CA and PTCA were for DAP 45 Gyxcm2 and 75 Gyxcm2, for fluoroscopy time 7.5 min and 17 min and for number of frames 1250 and 1300, respectively. The proposed RLs should be considered as a first approach to help in the optimisation of these procedures. More studies are required to establish certain "tolerances" from the proposed levels taking into account the complexity of the procedure and the patient's size.

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“…However, the extended use of these procedures raises various radiation protection issues, as they generally involve a long fluoroscopy time and large number of acquired images, thus resulting in high radiation doses to the patient as well as to the medical personnel [2][3][4][5][6][7]. Specifically, the dose to the patients' skin can, in some cases, even exceed the threshold of tissue reactions [8][9][10]. As a consequence, optimisation of radiation protection on IR and IC procedures is of great importance.…”

Section: Introductionmentioning

confidence: 99%