Skin radiation injuries in patients following repeated coronary angioplasty procedures

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Abstract
This study investigates the incidence of skin injuries and retrospectively estimates skin doses in a sample of patients who had multiple coronary angiographies and who underwent more than four percutaneous transluminal coronary angioplasties (PTCAs), performed primarily by the same team of cardiologists in a university hospital. A database of 7824 PTCAs performed during the last 14 years was analysed. Patients were selected and reviewed by a cardiologist and two radiotherapists with experience in radiation-induced skin injuries. A retrospective analysis of skin doses was performed using data from the patients' files and from the quality assurance (QA) programme of the hospital, which includes periodic patient dose measurements. 14 patients were included in the study. Each patient had undergone between 4 and 14 coronary angiographies and between 5 and 10 PTCAs, performed over a period of 2-10 years. The estimated mean dose-area product per procedure was 46 Gy cm(2) for coronary angiography and 82 Gy cm(2) for PTCA. Mean values of maximum skin dose per procedure were 217 mGy for the diagnostic studies and 391 mGy for the PTCAs. Only a slight radiation skin injury was clinically demonstrated in one patient with a history of 10 coronary angiographies and 10 PTCAs (estimated maximum skin dose 9.5 Gy). Another patient who underwent 14 coronary angiographies and 10 PTCAs (estimated maximum skin dose 7.3 Gy) showed a slight telangiectasia and discrete pigmentation. Another patient with a cutaneous lupus erythematosus showed pigmentation in the area of the radiation field following seven coronary angiographies and six PTCAs (estimated maximum skin dose 5.6 Gy), as expected bearing in mind that skin tolerance to high doses may be altered for patients with this pathology. Each of the remaining 11 patients with no skin injuries had undergone between 5 and 7 PTCAs and between 5 and 14 additional angiographies. None of the 14 patients reported acute skin injuries and no necrosis or radiodermatitis was observed.