Radiation-Induced Cutaneous Tissue Reactions in Neurointerventional Procedures: A Systematic Review of Reported...

Area of Science:

• Medical Imaging
• Radiation Oncology
• Dermatology

Background:

• Neurointerventional procedures utilize fluoroscopy or digital subtraction angiography, potentially delivering high localized skin doses.
• Radiation-induced cutaneous tissue reactions are a known risk, but specific dose thresholds for neurointerventional settings are not well-synthesized.

Purpose of the Study:

• To systematically review and synthesize reported cutaneous reactions and associated radiation doses following neurointerventional procedures.
• To establish dose thresholds for specific radiation-induced skin reactions in this patient population.

Main Methods:

• Systematic review following PRISMA 2020 guidelines, searching Ovid MEDLINE, Embase, Scopus, and Cochrane Library.
• Inclusion of case reports, case series, and observational studies reporting cutaneous reactions and/or skin doses.
• Narrative synthesis of findings, with separate reporting of cohort-derived incidence and case-level data.

Main Results:

• Twenty-five studies (approx. 686 patients) were included, with alopecia/epilation being the most common reaction (21 studies).
• Incidence ranged from 5% to 56%, increasing with skin dose and procedural complexity.
• Temporary epilation occurred around 3 Gy, while erythema and ulceration occurred at higher cumulative doses; lower doses caused epilation in radiosensitive patients.

Conclusions:

• Standardized reporting of peak skin dose is crucial for accurate assessment of radiation risks.
• Dose-triggered, structured follow-up protocols are needed to manage and monitor cutaneous reactions effectively.
• Further research is required to refine dose thresholds and optimize patient safety in neurointerventional procedures.