Department of Medicine, Columbia University Medical Center, 627 W 165th St, New York, NY 10021, USA.
Radiology. 2010 Feb;254(2):326-41. doi: 10.1148/radiol.2542082312.
Most advice currently available with regard to fluoroscopic skin reactions is based on a table published in 1994. Many caveats in that report were not included in later reproductions, and subsequent research has yielded additional insights. This review is a consensus report of current scientific data. Expected skin reactions for an average patient are presented in tabular form as a function of peak skin dose and time after irradiation. The text and table indicate the variability of reactions in different patients. Images of injuries to skin and underlying tissues in patients and animals are provided and are categorized according to the National Cancer Institute skin toxicity scale, offering a basis for describing cutaneous radiation reactions in interventional fluoroscopy and quantifying their clinical severity. For a single procedure performed in most individuals, noticeable skin changes are observed approximately 1 month after a peak skin dose exceeding several grays. The degree of injury to skin and subcutaneous tissue increases with dose. Specialized wound care may be needed when irradiation exceeds 10 Gy. Residual effects from radiation therapy and from previous procedures influence the response of skin and subcutaneous tissues to subsequent procedures. Skin irradiated to a dose higher than 3-5 Gy often looks normal but reacts abnormally when irradiation is repeated. If the same area of skin is likely to be exposed to levels higher than a few grays, the effects of previous irradiation should be included when estimating the expected tissue reaction from the additional procedure.
目前关于透视皮肤反应的大多数建议都是基于 1994 年发表的一篇文章。该报告中的许多注意事项在后来的复制品中并未包括，随后的研究也提供了更多的见解。本综述是当前科学数据的共识报告。以表格形式呈现了普通患者的预期皮肤反应，作为峰值皮肤剂量和照射后时间的函数。文本和表格表明了不同患者反应的可变性。提供了患者和动物皮肤和皮下组织损伤的图像，并根据美国国家癌症研究所的皮肤毒性量表进行分类，为介入透视术中描述皮肤辐射反应和量化其临床严重程度提供了基础。对于大多数人进行的单次手术，在峰值皮肤剂量超过几格雷后约 1 个月可观察到明显的皮肤变化。皮肤和皮下组织的损伤程度随剂量增加而增加。当照射超过 10Gy 时，可能需要专门的伤口护理。放射治疗和以前的手术的残留效应会影响皮肤和皮下组织对后续手术的反应。当照射剂量高于 3-5Gy 时，皮肤通常看起来正常，但当重复照射时会出现异常反应。如果同一部位的皮肤可能暴露在几格雷以上的剂量下，在估计额外手术的预期组织反应时，应包括先前照射的影响。
