Room: Track 1
Purpose: Substantial radiation dose levels (SRDL) alert staff to the possibility of radiation induced tissue injury from fluoroscopically guided interventional procedures (FGI). Anecdotally, it is very rare to observe such injuries, even at radiation levels much higher than SRDL. We investigated the likelihood of skin injury in patients who underwent FGI where SRDL were significantly exceeded.
Methods: Over 4-years, dose tracking software was used to record cumulative reference point air kerma (CAK) for FGI in a large health system. For each patient, total CAK (CAK6??) was determined by summing CAK from every FGI (of the same anatomical region) that occurred within a 6 month period. Patients were followed for skin injury if CAK6?? exceeded 10 Gy, which is double the NCRP suggested SRDL of 5 Gy summed over 6 months (NCRP-168). Skin assessment had to occur within 3 months of last FGI for patient inclusion in study.
Results: 38 patients met the study inclusion criteria of CAK6?? > 10 Gy and skin assessment within 3 months (mean time of skin assessment: 1.3±0.6 month after last FGI). There was no evidence of skin injury in 37 of 38 patients (97%). For these 37 patients, average CAK6?? was 12.5 Gy (range: 10.0 – 22.4 Gy). Only 1 patient (3%) exhibited skin injury (erythema, small scab, peeling skin, CAK6?? = 14.6 Gy), which healed in 2 months. Of note, CAK6?? exceeded 15 Gy (three times the NCRP recommended SRDL) in a small subset of 5 patients, all of whom exhibited no skin injury.
Conclusion: There was no evidence of skin injury in 97% of patients who underwent FGI with total CAK over twice the NCRP recommended SRDL. This suggests that skin injury is unlikely even at levels that significantly exceed SRDL. Future work aims to determine the peak skin dose in these patients.