Fluoroscopically Guided Interventional Procedures: A Review of Radiation Effects on Patients' Skin and Hair
 Radiation injury in a 60-year-old woman subsequent to successful neurointerventional procedure for the treatment of acute stroke. Estimated fluoroscopy time was more than 70 minutes; 43 imaging series’ were performed during course of the procedure. The head was not shaved. Note focal epilation on scalp and skin injury on neck but not on scalp. No dose estimates were available for this case. (Radiology 2010; 2:326-342) © RSNA, 2010. All rights reserved. Printed with permission. |
In the past two decades, radiation-induced skin damage has been recognized as a rare complication of fluoroscopically guided interventional procedures. Radiation dose, the interval between irradiations (dose fractionation) and the size of the skin area irradiated affect the expression and severity of the radiation injury, as do a variety of physical and patient-related factors
In a review article in the January issue of Radiology (RSNA.org/Radiology), Stephen Balter, Ph.D., and colleagues present a consensus based on available information of the radiobiology of the skin and the relationship between radiation dose and skin effects in interventional fluoroscopy. Specifically, authors examine:
- Clinical use of radiation
- Biologic factors that influence skin reactions
- Radiobiology of radiation injuries
- Initiating dose and time course of radiation injury
- Interaction between different types of damage
- Risk management of skin effects in interventional procedures
- Staged and repeated procedures
Authors also present expected skin reactions for an average patient in tabular form as a function of peak skin dose and time after irradiation.
"Rigid adherence to any dose-effect table is unwise," the authors conclude. "Because of clinical variability, it is appropriate to assume that any skin changes observed after a fluoroscopically guided interventional procedure are radiogenic in origin unless a definitive alternative diagnosis is established."
Current Concepts in the Evaluation of Multiple Myeloma with MR Imaging and FDG PET/CT
With improvement in chemotherapeutic options and the increased use of autologous transplantation, advanced imaging is becoming more important in the evaluation of multiple myeloma, which varies widely in its manifestations, aggressivity and histopathologic pattern.
|
|
In a review article in the January–February issue of RadioGraphics (RSNA.org/RadioGraphics), Christopher J. Hanrahan, M.D., Ph.D.; Carl R. Christensen, M.D.; and Julia R. Crim, M.D., of the University of Utah School of Medicine in Salt Lake City, review the epidemiologic profile, diagnostic criteria, clinical manifestations, genetic prognostic factors, staging, treatment and imaging of multiple myeloma, with emphasis on the increasingly important and complementary roles of MR imaging and fluorine 18 fluorodeoxyglucose (FDG) PET combined with CT.
Imaging features of the disease before and after treatment are described and illustrated in detail, with emphasis on potential pitfalls in diagnosis.
"Imaging plays an important role in the detection of bone marrow disease, characterization of the disease pattern, quantitation of focal lesions, depiction of extramedullary disease, and differentiation of multiple myeloma from other normal and pathologic processes, and the imaging findings may lead to alterations in staging and prognosis," the authors conclude. "Posttreatment MR imaging or FDG PET/CT of myeloma also may be useful for evaluating the response to therapy and assessing residual disease."
