Radiography (London, England : 1995) · 2026
Risk of radiation-induced skin injury in patients undergoing SIRT: Evaluation of trigger levels for radiation protection.
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Cucchiara A, Iannazzo E, Maggio S P, Liotta F, Plaia A, Vieni A, Maruzzelli L, Miraglia R
Аннотация
INTRODUCTION: Selective internal radiation therapy (SIRT) is a fluoroscopically-guided interventional procedure used in the treatment of primary and secondary hepatic tumors. This study evaluated the potential risk of radiation-induced skin injury in patients undergoing both the pre-SIRT work-up and the therapeutic administration, by assessing whether international trigger levels were exceeded for cumulative air kerma (Ka,r), defined as the air kerma measured at the patient entrance reference point. If trigger levels are exceeded, future checks are activated for patients.
METHODS: We retrospectively reviewed all SIRT and pre-SIRT procedures performed at a single tertiary referral center. Radiation dose metrics were extracted from radiation dose structured reports (RDSR), focusing on cumulative Ka,r and fluoroscopy time. Trigger levels were defined in accordance with ICRP, NCRP, CIRSE, and ESR recommendations (alert: 2 Gy; trigger: 5 Gy). Observed values were compared against these thresholds.
RESULTS: Across all procedures, Ka,r values remained below the 5 Gy trigger level. No patient exceeded the 2 Gy alert level. Fluoroscopy times varied according to anatomical complexity but did not result in critical exposure. No cases of radiation-induced skin effects were observed in follow-up.
CONCLUSION: SIRT and pre-SIRT procedures can be performed safely without exceeding critical thresholds for deterministic skin effects. Optimized protocols, operator experience, and systematic dose monitoring are essential to ensure patient safety in complex fluoroscopically guided procedures.
IMPLICATION FOR PRACTICE: In accordance with established principles of good radiological practice, a substantial reduction in radiation dose was achieved through optimization of acquisition parameters. Adopting patient-specific dose modulation based on BMI and radiological anatomy represents a practical strategy to optimize radiation exposure. Moreover, a structured telephone check at one month post-procedure appears sufficient to screen for skin toxicity.
LEVELS OF EVIDENCE: 3: retrospective observational study.
METHODS: We retrospectively reviewed all SIRT and pre-SIRT procedures performed at a single tertiary referral center. Radiation dose metrics were extracted from radiation dose structured reports (RDSR), focusing on cumulative Ka,r and fluoroscopy time. Trigger levels were defined in accordance with ICRP, NCRP, CIRSE, and ESR recommendations (alert: 2 Gy; trigger: 5 Gy). Observed values were compared against these thresholds.
RESULTS: Across all procedures, Ka,r values remained below the 5 Gy trigger level. No patient exceeded the 2 Gy alert level. Fluoroscopy times varied according to anatomical complexity but did not result in critical exposure. No cases of radiation-induced skin effects were observed in follow-up.
CONCLUSION: SIRT and pre-SIRT procedures can be performed safely without exceeding critical thresholds for deterministic skin effects. Optimized protocols, operator experience, and systematic dose monitoring are essential to ensure patient safety in complex fluoroscopically guided procedures.
IMPLICATION FOR PRACTICE: In accordance with established principles of good radiological practice, a substantial reduction in radiation dose was achieved through optimization of acquisition parameters. Adopting patient-specific dose modulation based on BMI and radiological anatomy represents a practical strategy to optimize radiation exposure. Moreover, a structured telephone check at one month post-procedure appears sufficient to screen for skin toxicity.
LEVELS OF EVIDENCE: 3: retrospective observational study.