Radiation-induced skin injuries from fluoroscopy

Since 1992, the U.S. Food and Drug Administration (FDA) has received reports of radiation-induced injuries to the skin in patients who had undergone fluoroscopically guided interventional procedures. The reports were investigated to determine the procedure- or equipment-related factors that may have contributed to the injury. The injuries ranged in severity from erythema to moist desquamation to tissue necrosis that required skin grafting. They occurred after a variety of interventional procedures that required extended periods of fluoroscopy compared with those of typical diagnostic procedures. Medical facilities and physicians should be aware of the magnitude of radiation doses to the skin that can result from the long exposure times required by complex interventional procedures. The FDA recommends several steps for reducing these injuries, including establishing protocols for each procedure, determining radiation dose rates for specific fluoroscopy systems and operating modes, and monitoring cumulative absorbed doses to areas of the skin.