Radiation effects in fluoroscopically guided cardiac interventions—keeping them under control

It would appear that a significant number of cardiologists are unaware that skin injuries ranging from erythema to telangiectasia or even dermal necrosis can be caused by the procedures they perform. Conditions that have been reported to be associated with radiation-induced skin injuries include: the high values of the exposure factors required with thick patients; prolonged or multiple procedures; elevated radiosensitivity of some patients (ataxia telangiectasia); connective tissue disease and diabetes mellitus. The total number of reported severe injuries worldwide so far is 100–200, or over 200 when all degrees of skin injuries are included, but the real number may be substantially larger since initial symptoms often appear only weeks after the procedure and the cardiologist may not be notified, unless a procedure for systematic follow up is in place. Besides skin injuries, patients—more so, the younger ones—incur a risk of radiation-induced cancer at some stage in the future. Experience shows that, with awareness of radiation safety aspects, proper equipment performance, the use of proper techniques, and the monitoring of patient doses, severe skin injuries should not occur in patients undergoing 5–10 PTCAs. However, for those patients whose radiation doses approach the thresholds for radiation injuries a systematic follow up is required. These issues are addressed here.