Radiation injuries after fluoroscopic procedures

Fluoroscopically guided diagnostic and interventional procedures have become much more commonplace over the last decade. Current fluoroscopes are easily capable of producing dose rates in the range of 0.2 Gy (20 rads) per minute. The dose rate often changes dramatically with patient positioning and size. Most machines currently in use have no method to display approximate patient dose other than the rough surrogate of total fluoroscopy time. This does not include patient dose incurred during fluorography (serial imaging or cine runs), which can be considerably greater than dose during fluoroscopy. There have been over 100 cases of documented radiation skin and underlying tissue injury, a large portion of which resulted in dermal necrosis. The true number of injuries is undoubtedly much higher. The highest dose procedures are complex interventions such as those involving percutaneous angioplasties, stent placements, embolizations, and TIPS. In some cases skin doses have been in excess of 60 Gy (6000 rads). In many instances the procedures have been performed by physicians with little training in radiation effects, little appreciation of the radiation injuries that are possible or the strategies that could have been used to reduce both patient and staff doses. Almost all of the severe injuries that have occurred were avoidable.