Rehani Madan M, Ortiz-Lopez Pedro
Radiological Protection of Patients Unit, International Atomic Energy Agency, Vienna Austria.
Int J Cardiol. 2006 May 10;109(2):147-51. doi: 10.1016/j.ijcard.2005.06.015. Epub 2005 Jul 19.
It would appear that a significant number of cardiologists are unaware that skin injuries ranging from erythema to telangiectasia or even dermal necrosis can be caused by the procedures they perform. Conditions that have been reported to be associated with radiation-induced skin injuries include: the high values of the exposure factors required with thick patients; prolonged or multiple procedures; elevated radiosensitivity of some patients (ataxia telangiectasia); connective tissue disease and diabetes mellitus. The total number of reported severe injuries worldwide so far is 100-200, or over 200 when all degrees of skin injuries are included, but the real number may be substantially larger since initial symptoms often appear only weeks after the procedure and the cardiologist may not be notified, unless a procedure for systematic follow up is in place. Besides skin injuries, patients-more so, the younger ones-incur a risk of radiation-induced cancer at some stage in the future. Experience shows that, with awareness of radiation safety aspects, proper equipment performance, the use of proper techniques, and the monitoring of patient doses, severe skin injuries should not occur in patients undergoing 5-10 PTCA-s. However, for those patients whose radiation doses approach the thresholds for radiation injuries a systematic follow up is required. These issues are addressed here.
相当数量的心脏病专家似乎并未意识到，他们所实施的手术可能会导致从红斑到毛细血管扩张甚至皮肤坏死等一系列皮肤损伤。据报道，与辐射诱导的皮肤损伤相关的情况包括：肥胖患者所需的高剂量照射因素；手术时间延长或多次进行手术；部分患者（共济失调毛细血管扩张症）的放射敏感性升高；结缔组织病和糖尿病。到目前为止，全球报告的严重损伤总数为100 - 200例，若将所有程度的皮肤损伤都包括在内则超过200例，但实际数字可能要大得多，因为最初症状往往在手术后数周才出现，而且心脏病专家可能不会收到通知，除非有系统的随访程序。除了皮肤损伤外，患者，尤其是年轻患者，在未来某个阶段还面临辐射诱发癌症的风险。经验表明，只要意识到辐射安全问题、设备性能良好、使用恰当技术并监测患者剂量，接受5 - 10次经皮冠状动脉腔内血管成形术（PTCA）的患者不应出现严重皮肤损伤。然而，对于那些辐射剂量接近辐射损伤阈值的患者，需要进行系统随访。本文将探讨这些问题。
