X-ray imaging and the skin: radiation biology, patient dosimetry and observed effects.

A wide variety of radiation-induced deterministic skin effects have been observed after X-ray guided interventions ranging from mild effects, such as transient erythema or temporary epilation, to severe effects, such as desquamation and necrosis. Radiation biologists have identified, in addition to absorbed dose to the skin, other factors that strongly influence the type and severity of a skin reaction, including exposure-related factors (dose rate, fractionation, the size of the exposed area and its site), biological factors (age, oxygen status, capillary density, hormonal status and genetic factors) and ethnic differences. A peak entrance skin dose of 2 Gy is an arbitrary, but pragmatic, threshold for radiation-induced skin effects after X-ray guided interventions. Transient skin injury originating in the epidermis is not expected in the average patient population at peak entrance skin doses up to 6 Gy. Serious skin effects are not likely to occur in clinical practice when optimised X-ray equipment is used in combination with good techniques for fluoroscopy and imaging. However, this might not be true for patients with biological factors that are associated with an increased sensitivity for radiation-induced skin reactions.