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INTRODUCTION

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Fluoroscopic radiation is a carcinogen that can also cause severe injury (“radiation burns”) in patients and practitioners. Figures 11-1,11-2,11-3,11-4 illustrate the severe effects of radiation. All effects pictured were caused by radiation associated with fluoroscopy. Note the characteristic demarcation of injuries with sharp borders, a feature usually but not always associated with severe radiation effects from fluoroscopy.

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FIGURE 11-1

Breast cancer and skin injuries induced by fluoroscopically guided intervention for pulmonary tuberculosis. (Adapted with permission from MacKenzie I. Breast cancer following multiple fluoroscopies. Br J Cancer. 1965;19:1-8.)

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FIGURE 11-2

Deep skin wound following 2 ablation procedures separated by 4 months and having occurred 6 and 10 months previously. Wound progressed into deep tissue necrosis and osteoradionecrosis of the ribs, shown approximately 4 years after procedures. (Copyright retained by patient and figure reproduced with permission.)

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FIGURE 11-3

Injury following percutaneous transluminal coronary angioplasty (PTCA) and stent placement involving 63 minutes of fluoroscopy and nearly 5000 frames of cine. This left anterior oblique (LAO) view with cranial tilt resulted in a large entrance dose build-up in the lower right back. The injury required grafting. (Adapted with permission from Wagner LK. Radiation dose management in interventional radiology. In: Balter S, Chan R, Shope T, eds. Interventional Brachytherapy—Fluoroscopically Guided Interventions (American Association of Physicists in Medicine Monograph #28). Madison, WI: Medical Physics Publishing; 2002;195-218.)

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FIGURE 11-4

Severe prolonged erythema and central area of induration and necrosis about 14 months following coronary intervention. (Reproduced with permission from Balter S, Hopewell JW, Miller DL, Wagner LK, Zelefsky MJ. Fluoroscopically guided interventional procedures: a review of radiation effects on patients’ skin and hair. Radiology. 2010;254:326-341, © RSNA.)

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Figure 11-11 is a breast cancer caused by fluoroscopically guided interventional procedures performed to cure pulmonary tuberculosis in the mid-20th century. Chronic radiation dermatitis is also readily apparent in this picture, taken in the 1960s approximately 10 to 15 years after exposure to the radiation.

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Figure 11-2 shows a deep necrotic wound following 2 ablation procedures 6 and 10 months previously. The ribs underlying the wound necrosed at about 4 years after the procedure. Advances in cardiac mapping during electrophysiologic procedures have mitigated the need for long-duration fluoroscopy and have reduced the likelihood of such effects in these patients.

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Figures 11-32 and 11-4 are skin injuries in patients who underwent fluoroscopically guided invasive cardiologic procedures. The patient in Figure 11-3 underwent coronary angioplasty and stent ...

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