title: Importance of a patient dosimetry and clinical follow-up program in the detection of radiodermatitis after long percutaneous coronary interventions.
abstract: OBJECTIVE
  Complex percutaneous interventions often require high radiation doses likely to produce skin radiation injuries. We assessed the methodology used to select patients with potential skin injuries in cardiac procedures and in need of clinical follow-up. We evaluated peak skin dose and clinical follow-up in a case of radiodermatitis produced during a total occlusion recanalization.
  
  
  METHODS
  This prospective study followed CIRSE and ACC/AHA/SCAI recommendations for patient radiation dose management in interventional procedures carried out in a university hospital with a workload of 4200 interventional cardiac procedures per year. Patient dose reports were automatically transferred to a central database. Patients exceeding trigger levels for air kerma area product (500 Gy cm(2)) and cumulative skin dose (5 Gy) were counseled and underwent follow-up for early detection of skin injuries, with dermatologic support. The Ethical Committee and the Quality Assurance and Radiation Safety Committee approved the program.
  
  
  RESULTS
  During 2010, a total of 13 patients (3.0/1,000 that year) received dose values exceeding trigger levels in the cardiovascular institute. Only one patient, who had undergone two consecutive procedures resulting in 970 Gy cm(2) and 13.0 Gy as cumulative skin dose, showed signs of serious radiodermatitis that resolved in 3.7 months. The remaining patients did not manifest skin lesions during follow-up, and whenever patient examination was not feasible as part of the follow-up, neither patients nor families reported any skin injuries.
  
  
  CONCLUSIONS
  Peak skin dose calculation and close clinical follow-up were feasible and appropriate, with a moderate additional workload for the staff and satisfaction for the patient.
authors.affiliation: Medical Physics Service and Radiology Department, Instituto de Investigación Sanitaria Hospital Clinico San Carlos and Complutense University, 28040, Madrid, Spain. eliseov@med.ucm.es
authors.forename: Eliseo
authors.initials: E
authors.lastname: Vano
authors.forename: Javier
authors.initials: J
authors.lastname: Escaned
authors.forename: Sergio
authors.initials: S
authors.lastname: Vano-Galvan
authors.forename: Jose M
authors.initials: JM
authors.lastname: Fernandez
authors.forename: Carmen
authors.initials: C
authors.lastname: Galvan
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D011829:Radiation Dosage; D011855:Radiodermatitis / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology; D015641:Radiography, Interventional / Q000009:adverse effects*; D011874:Radiometry / Q000379:methods*; D012867:Skin / Q000528:radiation effects