Radiation-induced Skin Injuries Research Articles

The effects of extracorporeal shock wave therapy on cutaneous radiation injury in a mouse model.

Although radiation-induced skin injuries are a concern in patients receiving radiation therapy, there are few effective treatments. The aim of this study was to evaluate the protective effects of extracorporeal shock wave therapy (ESWT) on irradiated fibroblasts and mouse skin. In the in vitro study of human dermal fibroblasts, the experimental group was subjected to ESWT following irradiation (20 Gy). The control groups were only irradiated or only subjected to ESWT. At 24 or 48 h post-ESWT, cell viability, cell migration, and mRNA and protein expression were measured. In the in vivo study, the experimental group (7 mice) was treated with ESWT following irradiation (45 Gy). The control group (7 mice) was only irradiated. At 8 weeks post-irradiation, dorsal skin was harvested for histopathologic examination and protein isolation. In dermal fibroblasts, treatment with ESWT increased viability of irradiated cells compared with irradiated-only and untreated cells (p = 0.005). ESWT increased cell migration 24 h post-irradiation (p = 0.002), and decreased TGF-β1 protein expression 48 h post-irradiation (p = 0.024). In mice, ESWT decreased the level of radiation-related skin injury (p = 0.006). Treatment of irradiated skin with ESWT decreased TGF-β1 (p = 0.009) and phospho-Smad3 (p = 0.009) protein expression, as well as decreasing myofibroblasts (p = 0.047) and increasing vessel density (p < 0.001). Our study demonstrated that ESWT alleviated radiation-induced fibrosis by downregulating TGF-β1 expression. It suggests the potential of ESWT for the treatment of radiation-induced fibrosis.

The regulatory mechanisms of cerium oxide nanoparticles in oxidative stress and emerging applications in refractory wound care.

Cerium oxide nanoparticles (CeNPs) have emerged as a potent therapeutic agent in the realm of wound healing, attributing their efficacy predominantly to their exceptional antioxidant properties. Mimicking the activity of endogenous antioxidant enzymes, CeNPs alleviate oxidative stress and curtail the generation of inflammatory mediators, thus expediting the wound healing process. Their application spans various disease models, showcasing therapeutic potential in treating inflammatory responses and infections, particularly in oxidative stress-induced chronic wounds such as diabetic ulcers, radiation-induced skin injuries, and psoriasis. Despite the promising advancements in laboratory studies, the clinical translation of CeNPs is challenged by several factors, including biocompatibility, toxicity, effective drug delivery, and the development of multifunctional compounds. Addressing these challenges necessitates advancements in CeNP synthesis and functionalization, novel nano delivery systems, and comprehensive bio effectiveness and safety evaluations. This paper reviews the progress of CeNPs in wound healing, highlighting their mechanisms, applications, challenges, and future perspectives in clinical therapeutics.

Color Texture Analysis as a Tool for Quantitative Evaluation of Radiation-Induced Skin Injuries

Background: Color texture analysis was applied as a tool for quantitative evaluation of radiation-induced skin injuries.Materials and Methods: We prospectively selected 20 breast cancer patients who underwent whole-breast radiotherapy after breast-conserving surgery. Color images of skin surfaces for irradiated breasts were obtained by using a mobile skin analyzer. The first skin measurement was performed before the first fraction of radiotherapy, and the subsequent measurement was conducted approximately 10 days after the completion of the entire series of radiotherapy sessions. For comparison, color images of the skin surface for the unirradiated breasts were measured similarly. For each color image, six co-occurrence matrices (red-green [RG], red-blue [RB], and green-blue [GB] from color channels, red [R], green [G], blue [B] from gray channels) can be generated. Four textural features (contrast, correlation, energy, and homogeneity) were calculated for each co-occurrence matrix. Finally, several statistical analyses were used to investigate the performance of the color textural parameters to objectively evaluate the radiation-induced skin damage.Results and Discussion: For the R channel from the gray channel, the differences in the values between the irradiated and unirradiated skin were larger than those of the G and B channels. In addition, for the RG and RB channels, where R was considered in the color channel, the differences were larger than those in the GB channel. When comparing the relative values between gray and color channels, the ‘contrast’ values for the RG and RB channels were approximately two times greater than those for the R channel for irradiated skin. In contrast, there were no noticeable differences for unirradiated skin.Conclusion: The utilization of color texture analysis has shown promising results in evaluating the severity of skin damage caused by radiation. All textural parameters of the RG and RB cooccurrence matrices could be potential indicators of the extent of skin damage caused by radiation.

FLASH Effects Induced by Orthovoltage X-Rays

This work describes the first implementation and in vivo study of ultrahigh-dose-rate radiation (>37 Gy/s; FLASH) effects induced by kilovoltage (kV) x-ray from a rotating-anode x-ray source. A high-capacity rotating-anode x-ray tube with an 80-kW generator was implemented for preclinical FLASH radiation research. A custom 3-dimensionally printed immobilization and positioning tool was developed for reproducible irradiation of a mouse hind limb. Calibrated Gafchromic (EBT3) film and thermoluminescent dosimeters (LiF:Mg,Ti) were used for in-phantom and in vivo dosimetry. Healthy FVB/N and FVBN/C57BL/6 outbred mice were irradiated on 1 hind leg to doses up to 43 Gy at FLASH (87 Gy/s) and conventional (CONV; <0.05 Gy/s) dose rates. The radiation doses were delivered using a single pulse with the widths up to 500 ms and 15 minutes at FLASH and CONV dose rates. Histologic assessment of radiation-induced skin damage was performed at 8 weeks posttreatment. Tumor growth suppression was assessed using a B16F10 flank tumor model in C57BL6J mice irradiated to 35 Gy at both FLASH and CONV dose rates. FLASH-irradiated mice experienced milder radiation-induced skin injuries than CONV-irradiated mice, visible by 4 weeks posttreatment. At 8 weeks posttreatment, normal tissue injury was significantly reduced in FLASH-irradiated animals compared with CONV-irradiated animals for histologic endpoints including inflammation, ulceration, hyperplasia, and fibrosis. No difference in tumor growth response was observed between FLASH and CONV irradiations at 35 Gy. The normal tissue sparing effects of FLASH irradiations were observed only for high-severity endpoint of ulceration at 43 Gy, which suggests the dependency of biologic endpoints to FLASH radiation dose. Rotating-anode x-ray sources can achieve FLASH dose rates in a single pulse with dosimetric properties suitable for small-animal experiments. We observed FLASH normal tissue sparing of radiation toxicities in mouse skin irradiated at 35 Gy with no sacrifice to tumor growth suppression. This study highlights an accessible new modality for laboratory study of the FLASH effect.

Study of EGCG composite hydrogel for the treatment of radiation-induced skin injuries.

With the rising incidence of cancer, radiotherapy has become an increasingly popular treatment modality. However, radiation-induced skin injuries (RSIs) have emerged as a commonly reported side effect of radiotherapy, thereby presenting a significant challenge in the field of radiotherapy. In this study, we report the successful synthesis of a photosensitive hydrogel via amide reaction for grafting the photosensitive group, methacrylate anhydride (MA), onto chitosan (CHI) and gelatin (GEL), with subsequent physical incorporation of epigallocatechin gallate (EGCG). The resulting composite photosensitive hydrogels exhibited favorable swelling properties, rheological properties, and biocompatibility, which promote angiogenesis and demonstrate notable therapeutic efficacy against RSIs. These findings provide valuable insights into the clinical utility of EGCG composite hydrogels for the effective management of RSIs.

Cooperation effects of radiation and ferroptosis on tumor suppression and radiation injury.

Ferroptosis is a kind of oxidative stress-dependent cell death characterized by iron accumulation and lipid peroxidation. It can work in conjunction with radiation to increase reactive oxygen species (ROS) generation and disrupt the antioxidant system, suppressing tumor progression. Radiation can induce ferroptosis by creating ROS, depleting glutathione, activating genes linked to DNA damage and increasing the expression of acyl-CoA synthetase long-chain family member 4 (ACSL4) in tumor cells. Furthermore, ferroptosis can enhance radiosensitivity by causing an iron overload, destruction of the antioxidant system, and lipid peroxidation. Radiation can also cause ferroptosis in normal cells, resulting in radiation injury. The role of ferroptosis in radiation-induced lung, intestinal, skin, and hematological injuries have been studied. In this review, we summarize the potential mechanisms linking ferroptosis, oxidative stress and radiation; analyze the function of ferroptosis in tumor suppression and radiation injury; and discuss the potential of ferroptosis regulation to improve radiotherapy efficacy and reduce adverse effects.

Plant and Herbal Extracts as Ingredients of Topical Agents in the Prevention and Treatment Radiodermatitis: A Systematic Literature Review

Background: The use of herbal extracts as the source of antioxidant substances capable of neutralizing free radicals and providing protection from ionizing radiation appears to be an alternative therapy for radiodermatitis. As concerns the prevention and treatment of side effects, a lot of recommendations are based on proper experience of radiotherapy centers. We summarize recent research aiming at reducing radiation-induced skin injuries by use of proper skin care, using topical preparations with herbal extracts including onco-cosmetics. Methods: This article is limited to a critical analysis of scientific and professional literature. It concerns preparations in different physicochemical forms, e.g., gels, emulsions, ointments. We stress the connection between the type of applied skin care (type of preparation, its composition, the dose), the properties of the herbal extract and the evaluation of its efficiency in preventing and treating radiation reaction on skin. Conclusions: Herbal extracts can be added to recipes because they are part of a category of cosmeceutical supplements and can be introduced into preparations without prescription. The effectiveness evaluation for herbal extracts in radiotherapy is not an easy task since there are no strict guidelines. Studies should be preceded by the analysis of herbal extracts and recipe in terms of physicochemical, dermatological and performance characteristics.

Morbidity in Patients with Nasopharyngeal Carcinoma and Radiation-Induced Skin Lesions: Cause, Risk Factors, and Dermatitis Evolution and Severity.

Radiation-induced skin injuries such as lesions (RSLs) and dermatitis are the most common complication during radiotherapy (RT) for nasopharyngeal carcinoma, but little is known about risk factors unique to oncology. This study sought a greater understanding of these risk factors to stratify patients based on risk and guide clinical decision-making. Investigators analyzed the data of 864 consecutive patients referred to the RT center of the Southern Theater General Hospital for a new RSL from 2013 to 2019. These patients were followed up for an average of approximately 16 months until their death or March 30, 2020, whichever came first. Multivariate logistic regression analysis and Cox proportional hazards model were used to identify predictors of grade 3 or 4 dermatitis. The main causes of treatment interruption included dermatitis and oral mucositis. Significant patient-specific risk factors for RSLs included current smoking, current drinking, and lower Karnofsky Performance Scale score and significant procedure-specific risk factors included receiving intensity-modulated radiation therapy (IMRT), hyperfractionated RT, induction chemotherapy, multicycle chemotherapy, and taxol- and cisplatin-based drugs. The three factors that independently predicted risk of RSL were IMRT, lower Karnofsky Performance Scale score, and multicycle chemotherapy. Comparing predictive factors among patients with severe RSL revealed that patients who received IMRT were more likely to develop grade 3 or 4 dermatitis. Oncology providers should note that IMRT is an aggressive technique with a trend toward increased RSL. Providers should pay special attention to adverse effects to skin in patients with nasopharyngeal carcinoma.

Adipose-Derived Stem Cells Therapy for Radiation-Induced Skin Injury.

Radiation-induced skin injuries have been treated with different medical therapies and have shown diverse outcomes. We aim to evaluate the effect of adipose-derived stem cells (ADSCs) therapy on radiation-induced skin injury. We performed a review by querying PubMed, Ovid MEDLINE, and EMBASE databases from inception to April 2020 following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The MeSH terms "adipose-derived stem cells," "wound healing," "radiation," and synonyms in combinations determined our search strategy. Experimental peer-reviewed articles describing the protocol and comparing the results with controls were included. Non-English studies were excluded. Our search recorded a total of 137 articles. Only 8 studies met our inclusion criteria and were included in this review. Five studies evaluated the use of ADSC alone, whereas the others evaluated the efficacy of ADSC seeded in scaffolds. Adipose-derived stem cell-based therapies, either alone or seeded in scaffolds, were shown to improve wound healing in most studies when compared with controls. There is evidence supporting the positive benefits from ADSC-based therapies in radiation-induced skin injury. However, further studies are needed to standardize the method of ADSC extraction, radiation-induced skin injury experimental model, and increase the time of follow-up to evaluate the results accurately.

The potential of radiation sterilized and banked tissue allografts for management of nuclear casualties.

Processed and radiation sterilized allograft tissues that can be banked for use on demand are a precious therapeutic resource for the repair or reconstruction of damaged or injured tissues. Skin dressings or skin substitutes like allograft skin, amniotic membrane and bioengineered skin can be used for the treatment of thermal burns and radiation induced skin injuries. Bone grafts can be employed for repairing fracture defects, filling in destroyed regions of bone, and treatment of spinal and joint injuries. A nuclear scenario would result in a large number of casualties due to the heat, blast and radiation effects of the weapon. Perspective of radiation sterilized biological tissues provided by the tissue banks for management of casualties in a nuclear disaster scenario is presented.

Molecular effects of photon irradiation and subsequent aftercare treatment with dexpanthenol-containing ointment or liquid in 3D models of human skin and non-keratinized oral mucosa.

This study aimed to investigate the molecular effects of radiation and subsequent aftercare treatment with dexpanthenol-containing ointment and liquid on established full-thickness 3D skin models depicting acute radiodermatitis and mucositis. To mimic radiomucositis and radiodermatitis, non-keratinized mucous membrane and normal human skin models were irradiated with 5 Gray. Afterwards, models were treated topically every second day with dexpanthenol-containing ointment or liquid in comparison with placebo and untreated controls. On day 7 after irradiation, histological examination showed impairments in irradiated models. In contrast, models treated with dexpanthenol-containing ointment or liquid showed a completely restored epidermal part. While gene expression profiling revealed an induction of genes related to a pro-inflammatory milieu, oxidative stress and an impaired epidermal differentiation after irradiation of the models, aftercare treatment with dexpanthenol-containing ointment or liquid revealed anti-oxidative and anti-inflammatory effects and had a positive effect on epidermal differentiation and structures important for physical and antimicrobial barrier function. Our findings confirm the potential of our established models as in vitro tools for the replacement of pharmacological in vivo studies regarding radiation-induced skin injuries and give indications of the positive effects of dexpanthenol-containing externals after radiation treatments as part of supportive tumor treatment.

Cutaneous Radiation Injuries: Models, Assessment and Treatments.

Many cases of human exposures to high-dose radiation have been documented, including individuals exposed during the detonation of atomic bombs in Hiroshima and Nagasaki, nuclear power plant disasters (e.g., Chernobyl), as well as industrial and medical accidents. For many of these exposures, injuries to the skin have been present and have played a significant role in the progression of the injuries and survivability from the radiation exposure. There are also instances of radiation-induced skin complications in routine clinical radiotherapy and radiation diagnostic imaging procedures. In response to the threat of a radiological or nuclear mass casualty incident, the U.S. Department of Health and Human Services tasked the National Institute of Allergy and Infectious Diseases (NIAID) with identifying and funding early- to mid-stage medical countermeasure (MCM) development to treat radiation-induced injuries, including those to the skin. To appropriately assess the severity of radiation-induced skin injuries and determine efficacy of different approaches to mitigate/treat them, it is necessary to develop animal models that appropriately simulate what is seen in humans who have been exposed. In addition, it is important to understand the techniques that are used in other clinical indications (e.g., thermal burns, diabetic ulcers, etc.) to accurately assess the extent of skin injury and progression of healing. For these reasons, the NIAID partnered with two other U.S. Government funding and regulatory agencies, the Biomedical Advanced Research and Development Authority (BARDA) and the Food and Drug Administration (FDA), to identify state-of-the-art methods in assessment of skin injuries, explore animal models to better understand radiation-induced cutaneous damage and investigate treatment approaches. A two-day workshop was convened in May 2019 highlighting talks from 28 subject matter experts across five scientific sessions. This report provides an overview of information that was presented and the subsequent guided discussions.

Cutaneous Radiation Injuries: Models, Assessment and Treatments.

Many cases of human exposures to high-dose radiation have been documented, including individuals exposed during the detonation of atomic bombs in Hiroshima and Nagasaki, nuclear power plant disasters (e.g., Chernobyl), as well as industrial and medical accidents. For many of these exposures, injuries to the skin have been present and have played a significant role in the progression of the injuries and survivability from the radiation exposure. There are also instances of radiation-induced skin complications in routine clinical radiotherapy and radiation diagnostic imaging procedures. In response to the threat of a radiological or nuclear mass casualty incident, the U.S. Department of Health and Human Services tasked the National Institute of Allergy and Infectious Diseases (NIAID) with identifying and funding early- to mid-stage medical countermeasure (MCM) development to treat radiation-induced injuries, including those to the skin. To appropriately assess the severity of radiation-induced skin injuries and determine efficacy of different approaches to mitigate/treat them, it is necessary to develop animal models that appropriately simulate what is seen in humans who have been exposed. In addition, it is important to understand the techniques that are used in other clinical indications (e.g., thermal burns, diabetic ulcers, etc.) to accurately assess the extent of skin injury and progression of healing. For these reasons, the NIAID partnered with two other U.S. Government funding and regulatory agencies, the Biomedical Advanced Research and Development Authority (BARDA) and the Food and Drug Administration (FDA), to identify state-of-the-art methods in assessment of skin injuries, explore animal models to better understand radiation-induced cutaneous damage and investigate treatment approaches. A two-day workshop was convened in May 2019 highlighting talks from 28 subject matter experts across five scientific sessions. This report provides an overview of information that was presented and the subsequent guided discussions.

Evaluation of proton beam radiation-induced skin injury in a murine model using a clinical SOBP.

The purpose of this paper is to characterize the skin deterministic damage due to the effect of proton beam irradiation in mice occurred during a long-term observational experiment. This study was initially defined to evaluate the insurgence of myelopathy irradiating spinal cords with the distal part of a Spread-out Bragg peak (SOBP). To the best of our knowledge, no study has been conducted highlighting high grades of skin injury at the dose used in this paper. Nevertheless these effects occurred. In this regard, the experimental evidence of significant insurgence of skin injury induced by protons using a SOBP configuration will be shown. Skin damages were classified into six scores (from 0 to 5) according to the severity of the injuries and correlated to ED50 (i.e. the radiation dose at which 50% of animals show a specific score) at 40 days post-irradiation (d.p.i.). The effects of radiation on the overall animal wellbeing have been also monitored and the severity of radiation-induced skin injuries was observed and quantified up to 40 d.p.i.

Polysaccharides from Annona muricata leaves protect normal human epidermal keratinocytes and mice skin from radiation-induced injuries

Radiation-induced skin injuries are a common side effect of radiotherapy. Plant-derived polysaccharide is considered as an attractive cosmeceutical ingredient for skin damage therapy. This study was conducted to investigate the protective effects of Annona muricata leaf polysaccharide (ALP) on radiation-induced skin injuries by using in vitro and in vivo models. In normal human epidermal keratinocytes (NHEKs), ALP treatments reduced irradiation-induced apoptosis by increasing antioxidant enzymes activities, including superoxide dismutase (SOD) and catalase. Furthermore, ALP treatments decreased levels of interleukin-1β, nucleotide-binding domain and leucine-rich-repeat-containing family pyrin 3 (NLRP3), and cleavage of caspase-1 and caspase-3. Most importantly, the topical application of the ALP cream showed protective efficacy against irradiation exposure, including the reduction of epidermal thickening, as well as an increase in the number of apoptotic cells and antioxidant enzyme (SOD and catalase) activities in skin tissue. Our results indicate that ALP can be potentially used to treat radiation-induced skin injuries.

Patient doses in endovascular and hybrid revascularization of the lower extremities.

Hybrid surgical methods such as remote endarterectomy and endovascular revascularization are fluoroscopy-guided procedures successfully replacing conventional open surgery for treatment of peripheral artery disease (PAD). The aim of this study was to: (1) evaluate the dose parameters describing exposure of patients undergoing endovascular or hybrid revascularization of the lower limb (below the inguinal ligament); (2) compare the data available in the literature with the evaluations of patients' dose values and related factors for patients undergoing such procedures; (3) examine the correlation of doses with certain parameters; (4) estimate the peak skin dose and assess the potential for radiation-induced skin injuries during the procedures. Data for 259 patients were extracted retrospectively and analyzed. The procedures were grouped by type of intervention, vascular approach, and level of complexity. The analyses included the correlation of dose values with the operating team. The air kerma-area product (KAP) and fluoroscopy time (FT) values greatly varied depending on the procedure type but also among patients undergoing the same procedure. The type of vascular access has the largest impact on patients' doses. The KAP and FT values for brachial artery were: 347 Gy.cm2 and FT: NA; for contralateral common femoral artery (CFA) approach: 207 Gy.cm2 and 153 s; e.g. significantly higher than for ipsilateral CFA: 96 Gy.cm2 and 78 s; for hybrid surgery: 77 Gy.cm2 and 41 s; and for ipsilateral retrograde popliteal approach: 61 Gy.cm2 and 53 s. The same tendency is observed for the peak skin dose (PSD) values: the highest are for brachial artery (2053 mGy) and contralateral CFA (1325 mGy) approach, followed by the ipsilateral CFA (748 mGy), hybrid surgery (649 mGy), and ipsilateral retrograde popliteal approach (566 mGy). Registered dose values and FT for the different procedures do not exceed the International Atomic Energy Agency (IAEA) proposed trigger values for patients' follow-up for radiation-induced skin injuries. The type of vascular access has the highest negative impact on radiation dose levels and resultant KAP, PSD, and FT values. There is a significant increase of the dose values with increase of the number of inserted stents and the level of complexity. This should be considered in planning, especially for patients who undergo multiple diagnostic and therapeutic procedures. This study gives a systematic understanding for patient radiation exposure in endovascular and hybrid revascularization of the lower extremities, thus far absent in the literature.

Metformin Alleviates Radiation-Induced Skin Fibrosis via the Downregulation of FOXO3

Background/Aims: Radiation-induced skin fibrosis is a common side effect of clinical radiotherapy. Our previous next-generation sequencing (NGS) study demonstrated the reduced expression of the regulatory α subunit of phosphatidylinositol 3-kinase (PIK3r1) in irradiated murine skin. Metformin has been reported to target the PIK3-FOXO3 pathway. In this study, we investigated the effects of metformin on radiation-induced skin fibrosis. Methods: Metformin was orally administered to irradiated mice. Skin fibrosis was analyzed by staining with H&E and Masson’s trichrome stain. The levels of cytokines and chemokines associated with fibrosis were analyzed by immunohistochemistry and quantitative RT-PCR. The roles of PIK3rl and FOXO3 in radiation-induced skin fibrosis were studied by overexpressing PIK3rl and transfecting FOXO3 siRNA in NIH3T3 cells and mouse-derived dermal fibroblasts (MDF). Results: The oral administration of metformin significantly reduced radiation-induced skin thickening and collagen accumulation and significantly reduced the radiation-induced expression of FOXO3 in murine skin. Additionally, the overexpression of PIK3r1 reduced the radiation-induced expression of FOXO3, while FOXO3 silencing decreased the radiation-induced expression of TGFβ in vitro. Conclusions: The results indicated that metformin suppresses radiation-induced skin injuries by modulating the expression of FOXO3 through PIK3r1. Collectively, the data obtained in this study suggested that metformin could be a potent therapeutic agent for alleviating radiation-induced skin fibrosis.

Lessons from two cases of radiation induced skin injuries in fluoroscopic procedures in Bulgaria

Background: Radiation-induced injuries to patient skin as a result of fluoroscopy guided interventional procedures are infrequently reported, often misdiagnosed and there is a need to learn lessons from every injury. Methods: This paper describes two cases of radiation induced skin injuries that are, to the best of our knowledge, the first ever reported cases from Bulgaria and possibly from Eastern Europe, and would thus have educational value. Results: The important messages from the skin injuries reported here are: lack of awareness among part of the interventional specialists about the potential for radiation induced skin injury, misdiagnosis after injury happened because of lack of awareness and knowledge among general physicians, dermatologists and surgeons who followed up cases of skin injuries; the lack of system to monitor patients with relatively high exposure; the important role played by the medical physicist in diagnosing the injury and overall in initiating actions; the role of training and informational material displayed in interventional facilities. Conclusions: For avoidance of skin injuries from interventional procedures it is of utmost importance to implement a system that includes (a) regular monitoring of radiation dose parameters of the procedure; (b) established trigger values for reporting; (c) procedure for patient follow-up if a trigger value is exceeded; (d) instructing the patient who has received exposure above the trigger value to self-examine the irradiated area of the skin for any itching/redness and report it back.

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

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.

Abstract No. 541 - Retrospective analysis of fluoroscopy procedures with high radiation doses: Incidence of radiation induced skin injuries (RISIs)

Abstract No. 541 - Retrospective analysis of fluoroscopy procedures with high radiation doses: Incidence of radiation induced skin injuries (RISIs)