Radiation Effects of Fluoroscopy on Patients’ Skin and Hair

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Cardiac-Interventional Radiography: 2.00
Patient Care: 1.00
Patient Interactions and Management: 1.00
Image Production: 1.00
Image Acquisition and Equipment: 1.00

Computed Tomography: 1.00
Safety: 1.00
Radiation Safety and Dose: 1.00

Nuclear Medicine Technology: 1.75
Safety: 1.75
Radiation Physics, Radiobiology, and Regulations: 1.75

Radiography: 2.00
Safety: 2.00
Radiation Physics and Radiobiology: 1.25
Radiation Protection: 0.75

Registered Radiologist Assistant: 2.00
Safety: 2.00
Patient Safety, Radiation Protection, and Equipment Operation: 2.00

Radiation Therapy: 1.75
Safety: 1.75
Radiation Protection, Equipment Operation, and Quality Assurance: 1.75

Vascular-Interventional Radiography: 2.00
Patient Care: 1.00
Patient Interactions and Management: 1.00
Image Production: 1.00
Image Acquisition and Equipment: 1.00

Outline

1. Introduction
2. Background
3. Clinical Use of Radiation
4. Biologic Factors That Influence Skin Reactions
5. Radiobiology of Radiation Injuries
6. Initiating Dose and Time Course of Radiation Injury
   1. Prompt Reactions
   2. Early Reactions
   3. Midterm Reactions
   4. Long-term Reactions
   5. Time Sequence
7. Interaction between Different Types of Damage
8. Risk Management of Skin Effects in Interventional Procedures
9. Staged and Repeated Procedures
10. Discussion
11. Appendix

Objectives

Upon completion of this course, students will:

1. know the time frame when a noticeable skin change is observed after a peak dose
2. be able to recognize the essential factors of radiation effects related to fluoroscopy-guided procedures
3. be familiar with steps necessary to manage radiation exposure to patients
4. understand that the fluoroscopy time is not a good indicator of skin injury
5. be familiar with what factor increases backscatter
6. be familiar with the physical and patient-related factors that can affect the expression of skin injury
7. be familiar with the body regions that are relatively resistant sites to the development of skin damage
8. be familiar with which body regions are the most sensitive sites to the development of skin damage
9. be able to recognize disorders associated with increased radio-sensitivity
10. be familiar with drugs associated with radiation recall
11. recognize an inflammatory skin condition which occurs in a previously irradiated body part after drug administration
12. be familiar with the properties of repopulation of skin cells
13. be familiar with the organization responsible for defining the 5 grades of skin toxicity
14. be familiar with the so-called 24-hour erythematous reaction
15. be familiar with reactions observed between 2 and 8 weeks after exposure
16. be familiar with reactions observed more than 40 weeks after irradiation
17. be able to recognize a long-term reaction resulting from dilation of capillaries more than 52 weeks after irradiation
18. be familiar with reactions in which there is development of delayed lesions in the walls of blood vessels in the dermis and subcutaneous fat
19. be able to compare a healed wound and non-irradiated skin with regard to potential breakdown
20. be familiar with skin dose range associated with A1 dose band scale
21. be familiar with recommended advice associated with A2 dose band scale
22. be familiar with recommended advice associated with B dose band scale
23. be familiar with skin dose range associated with D dose band scale
24. be familiar with skin dose range associated with C dose band scale
25. be familiar with recommended advice associated with A1 dose band scale
26. be familiar with skin dose range associated with B dose band scale
27. be familiar with recommended advice associated with C dose band scale
28. be familiar with skin dose range associated with A2 dose band scale
29. be familiar with recommended advice associated with D dose band scale
30. be familiar with the influence of residual effects from previous procedures
31. know the best indicator of cumulative skin dose
32. recognize how NCI skin toxicity grade 1 manifests in patients
33. recognize how NCI skin toxicity grade 2 manifests in patients
34. recognize how NCI skin toxicity grade 3 manifests in patients
35. recognize how NCI skin toxicity grade 4 manifests in patients