Skin injuries from fluoroscopically guided procedures: part 2, review of 73 cases and recommendations for minimizing dose delivered to patient.

13 he benefits of fluoroscopically guided interventional procedures are reflected in the increasing number of interventions that are performed each year. In 1996, more than 700,000 interventional procedures were performed in the United States [1, 2]. However, these procedures can deliver a high radiation dose to a patient’s skin. Unfortunately, some patients have been injured by the radiation [3–28]. In this report we review 73 cases of radiation-induced skin injury directly related to interventional work [3–28]. Most cases (67) were reported within the last 5 years (1996–2000). Seven cases originate from Wolff D (1999, personal communication), and nine cases originate from our own observations [21, 25] (Table 1). More are known; however, data are presently unavailable because of legal proceedings. Twenty of 26 cases reported to the United States Food and Drug Administration between 1992 and 1995 [6] were not included in our review because no details about procedures and skin damage were mentioned. In part 1 of this two-part series [29], we reviewed the biology and progression of skin injuries with examples from our database of 73 patients. In this report, we examine the same 73 patients for common features that may explain the causes of these injuries and identify ways to reduce the radiation dose to the skin. Case Reports The site of the skin injury depends on the type of procedure and corresponds in all cases to the beam entrance site. The site of injury is on the back when the tube is in a posteroanterior projection (e.g., transjugular intrahepatic portosystemic shunt (TIPS) placements or some coronary procedures), over the scapula when the beam is oriented in a left or right anterior oblique plane (e.g., coronary interventions), or in the axilla when the tube is positioned laterally (e.g., radiofrequency ablation and some coronary interventions).