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Radiation Injury to Skin Following Fluoroscopically Guided Procedures

Radiation Injury to Skin Following Fluoroscopically Guided Procedures Abstract IN SEPTEMBER 1994, the Food and Drug Administration (FDA) circulated a medical bulletin informing physicians and other health care professionals that several reports (to the FDA) of serious radiation injuries to skin had resulted from prolonged fluoroscopic imaging during interventional therapeutic procedures.1 Long exposure times, high dose rates, and operators' lack of awareness that the doses used exceeded the threshold for radiodermatitis all were implicated. Several procedures involving fluoroscopic exposure times that were potentially prolonged, repetitious, or both were listed, including percutaneous transluminal angioplasty, radiofrequency cardiac catheter ablation, vascular embolization, stent and filter placement, thrombolytic and fibrinolytic procedures, and percutaneous transhepatic cholangiography for portal decompression. It was emphasized that for single short-term exposures, the threshold dose was about 3 Gy (1 Gy is equivalent to 100 rad) for temporary epilation, 6 to 8 Gy for erythema (at 200 kV), and 15 Gy or higher for moist desquamation, References 1. Avoidance of Serious X-ray-Induced Skin Injuries to Patients During Fluoroscopically Guided Procedures . Washington, DC: Food and Drug Administration; (September 9) , 1994:1-6. 2. Lichenstein DA, Klapholz L, Vardy DA, et al. Chronic radiodermatitis following cardiac catheterization . Arch Dermatol. 1996;132:663-667.Crossref 3. Yuhas JM, Storer JB. Differential chemoprotection of normal and malignant tissues . J Natl Cancer Inst. 1969;42:331-335. 4. Ward WF, Molteni A, Ts'ao C, Hinz JM. The effect of captopril on benign and malignant reactions in irradiated rat skin . Br J Radiol. 1990;63:349-354.Crossref 5. Ward WF, Lin PJP, Wong PS, Behnia R, Jalali N. Radiation pneumonitis in rats and its modification by the angiotensin converting enzyme inhibitor captopril evaluated by high resolution tomography . Radiat Res. 1993;135:81-87.Crossref 6. Hanson WR, Thomas C. 16,16-Dimethyl prostaglandin E2 increases survival of murine intestinal stem cells when given before photon radiation . Radiat Res 1993;93:393-398. 7. Robert A, Nezamis JE, Lancaster C, Hancher AJ. Cytoprotection by prostaglandins in rats . Gastroenterology. 1979;77:433-443. 8. Hanson WR, Ainsworth EJ. Dimethyl prostaglandin E2 induces radioprotection in murine intestinal and hematopoietic stem cells . Radiat Res. 1985;103:196-203.Crossref 9. Hanson WR, Pelka AE, Nelson AK, Malkinson FD. 16,16-Dimethyl prostaglandin E2 protects from acute radiation-induced alopecia in mice . Clin Res. 1988; 36:906. Abstract. 10. Hanson WR, Pelka AE, Nelson AK, Malkinson FD. Subcutaneous or topical administration of 16,16-dimethyl prostaglandin E2 protects from radiationinduced alopecia in mice . Int J Radiat Oncol Biol Phys. 1992;23:333-337.Crossref 11. Geng L, Hanson WR, Malkinson FD. Topical or systemic 16,16-dimethyl prostaglandin E2 or WR-2721 (WR-1065) protects mice from alopecia after fractionated irradiation . Int J Radiat Biol. 1992;61:533-537.Crossref 12. Hanson WR, Geng L, Malkinson FD. Prostaglandin-induced protection from radiation or doxorubicin is tissue specific in mice . J Invest Dermatol. 1995; 104:606. Abstract. 13. Malkinson FD, Geng L, Hanson WR. Prostaglandins protect against murine hair injury produced by ionizing radiation or doxorubicin . J Invest Dermatol. 1993;101( (suppl) ):135-137.Crossref 14. Hanson WR. Eicosanoid-induced radioprotection and chemoprotection of normal tissue during cancer treatment . In: Harris JE, Braun DP, Anderson KM, eds. Prostaglandin Inhibitors in Tumor Immunology and Immunotherapy . Boca Raton, Fla: CRC Press Inc; 1994:171-186. 15. Hanson WR, Zhen W, Geng L, Hunter N, Milas L. The prostaglandin E1 analog, misoprostol, a normal tissue protector, does not protect four murine tumors in vivo from radiation injury . Radiat Res. 1995;142:281-287.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Radiation Injury to Skin Following Fluoroscopically Guided Procedures

Archives of Dermatology , Volume 132 (6) – Jun 1, 1996

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Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1996.03890300123017
Publisher site
See Article on Publisher Site

Abstract

Abstract IN SEPTEMBER 1994, the Food and Drug Administration (FDA) circulated a medical bulletin informing physicians and other health care professionals that several reports (to the FDA) of serious radiation injuries to skin had resulted from prolonged fluoroscopic imaging during interventional therapeutic procedures.1 Long exposure times, high dose rates, and operators' lack of awareness that the doses used exceeded the threshold for radiodermatitis all were implicated. Several procedures involving fluoroscopic exposure times that were potentially prolonged, repetitious, or both were listed, including percutaneous transluminal angioplasty, radiofrequency cardiac catheter ablation, vascular embolization, stent and filter placement, thrombolytic and fibrinolytic procedures, and percutaneous transhepatic cholangiography for portal decompression. It was emphasized that for single short-term exposures, the threshold dose was about 3 Gy (1 Gy is equivalent to 100 rad) for temporary epilation, 6 to 8 Gy for erythema (at 200 kV), and 15 Gy or higher for moist desquamation, References 1. Avoidance of Serious X-ray-Induced Skin Injuries to Patients During Fluoroscopically Guided Procedures . Washington, DC: Food and Drug Administration; (September 9) , 1994:1-6. 2. Lichenstein DA, Klapholz L, Vardy DA, et al. Chronic radiodermatitis following cardiac catheterization . Arch Dermatol. 1996;132:663-667.Crossref 3. Yuhas JM, Storer JB. Differential chemoprotection of normal and malignant tissues . J Natl Cancer Inst. 1969;42:331-335. 4. Ward WF, Molteni A, Ts'ao C, Hinz JM. The effect of captopril on benign and malignant reactions in irradiated rat skin . Br J Radiol. 1990;63:349-354.Crossref 5. Ward WF, Lin PJP, Wong PS, Behnia R, Jalali N. Radiation pneumonitis in rats and its modification by the angiotensin converting enzyme inhibitor captopril evaluated by high resolution tomography . Radiat Res. 1993;135:81-87.Crossref 6. Hanson WR, Thomas C. 16,16-Dimethyl prostaglandin E2 increases survival of murine intestinal stem cells when given before photon radiation . Radiat Res 1993;93:393-398. 7. Robert A, Nezamis JE, Lancaster C, Hancher AJ. Cytoprotection by prostaglandins in rats . Gastroenterology. 1979;77:433-443. 8. Hanson WR, Ainsworth EJ. Dimethyl prostaglandin E2 induces radioprotection in murine intestinal and hematopoietic stem cells . Radiat Res. 1985;103:196-203.Crossref 9. Hanson WR, Pelka AE, Nelson AK, Malkinson FD. 16,16-Dimethyl prostaglandin E2 protects from acute radiation-induced alopecia in mice . Clin Res. 1988; 36:906. Abstract. 10. Hanson WR, Pelka AE, Nelson AK, Malkinson FD. Subcutaneous or topical administration of 16,16-dimethyl prostaglandin E2 protects from radiationinduced alopecia in mice . Int J Radiat Oncol Biol Phys. 1992;23:333-337.Crossref 11. Geng L, Hanson WR, Malkinson FD. Topical or systemic 16,16-dimethyl prostaglandin E2 or WR-2721 (WR-1065) protects mice from alopecia after fractionated irradiation . Int J Radiat Biol. 1992;61:533-537.Crossref 12. Hanson WR, Geng L, Malkinson FD. Prostaglandin-induced protection from radiation or doxorubicin is tissue specific in mice . J Invest Dermatol. 1995; 104:606. Abstract. 13. Malkinson FD, Geng L, Hanson WR. Prostaglandins protect against murine hair injury produced by ionizing radiation or doxorubicin . J Invest Dermatol. 1993;101( (suppl) ):135-137.Crossref 14. Hanson WR. Eicosanoid-induced radioprotection and chemoprotection of normal tissue during cancer treatment . In: Harris JE, Braun DP, Anderson KM, eds. Prostaglandin Inhibitors in Tumor Immunology and Immunotherapy . Boca Raton, Fla: CRC Press Inc; 1994:171-186. 15. Hanson WR, Zhen W, Geng L, Hunter N, Milas L. The prostaglandin E1 analog, misoprostol, a normal tissue protector, does not protect four murine tumors in vivo from radiation injury . Radiat Res. 1995;142:281-287.Crossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Jun 1, 1996

References