Though skin injury from radiation cannot always be avoided, there are measures that can be taken before, during and after screening to minimize the likelihood and severity of injuries, according to a review published in the April American Journal of Roentgenology.

Co-authors Stephen Balter of Columbia University Medical Center in New York and Donald L. Miller of the U.S. Food and Drug Administration in Silver Spring, Maryland, first suggested doing research into any previous radiation to the area of the patient’s body that is planned to undergo a potentially high-dose procedure. The time interval should be determined and other factors that could increase the chances of tissue effect such as obesity or certain genetic disorders should be considered.

“If a potentially high-dose procedure is planned—or there is an increased likelihood of a skin injury because of previous skin irradiation, patient obesity, or any of the other aforementioned factors—the possibility of a skin injury should be part of the informed consent discussion,” wrote Balter and Miller.

The authors also contested the need for fluoroscopic equipment during high-dose procedures and emphasized that the basic principles of radiation safety during fluoroscopy should be followed. Dose metrics should be monitored during the procedure, and radiation delivery should be conserved as metrics increase.

After the procedure, the patient’s radiation dose metrics should be recorded in his or her medical record. "The patient should be advised of the radiation dose and possible sequelae, instructed to perform self-examination four weeks after the procedure, and given instructions on what to look for, where to look, and who to call at the facility if there are any questions,” wrote the authors.

“Skin injury cannot always be avoided, but it should never come as a surprise to the interventionalist or patient,” they concluded.