title: Objective measurements of radiotherapy-induced erythema.
abstract: OBJECTIVE
  The development of acute radiation erythema is a common phenomenon among patients under-going radiotherapy treatment. Because of the absence of reliable objective classification methods, the degree of skin reaction can at present mainly be judged subjectively in the clinic. This has motivated the present preliminary study,concerning the first steps in the development of an objective method for skin reaction classification.
  
  
  METHODS
  Three non-invasive techniques were used:near-infrared (NIR) spectroscopy, laser Doppler perfusion imaging and digital photography. The NIR spectra were analysed with principal component analysis (PCA), and the results from the other two with traditional univariate methods. Measurements were made on breast cancer patients who had been exposed to different irradiation doses. A total of 28 breast cancer patients participated one to three times each; 12 were treated with photons at 4 or 6MeV and 16 were treated with high-energy electrons between 10 and 20 MeV to a maximum dose of 50 Gy.
  
  
  RESULTS
  PCA of NIR spectra shows that information on radiation dose lies mainly in the first principal component. It is observed that the higher the dose the higher the score value. The results from the laser Doppler measurements show that in 79% of the cases the perfusion increases significantly with radiation dose. Analysis of the digital photography shows that a proposed skin redness index(SRI), increases with a higher radiation dose. However,the increase in most cases is not significant. By combining all data, correlation to radiation doses was seen for 74% of the patients who participated more than once.
  
  
  CONCLUSIONS
  All three non-invasive methods correlate with the radiation dose but to various degrees. NIR spectroscopy, laser Doppler and a combination of the three techniques are the most promising methods for characterising erythema.
authors.affiliation: Department of Chemistry, Analytical Chemistry, Umeå University, Sweden.
authors.forename: Josefina
authors.initials: J
authors.lastname: Nyström
authors.forename: Paul
authors.initials: P
authors.lastname: Geladi
authors.forename: Britta
authors.initials: B
authors.lastname: Lindholm-Sethson
authors.forename: Jenny
authors.initials: J
authors.lastname: Rattfelt
authors.forename: Ann-Christin
authors.initials: AC
authors.lastname: Svensk
authors.forename: Lars
authors.initials: L
authors.lastname: Franzen
mesh_terms: D001943:Breast Neoplasms / Q000532:radiotherapy; D004307:Dose-Response Relationship, Radiation; D004890:Erythema / Q000145:classification / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D017078:Laser-Doppler Flowmetry / Q000379:methods*; D015999:Multivariate Analysis; D010781:Photography / Q000379:methods*; D011855:Radiodermatitis / Q000145:classification / Q000175:diagnosis / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012815:Signal Processing, Computer-Assisted; D013055:Spectrophotometry, Infrared / Q000379:methods*