Tissue Reactions (Deterministic Effects) in Diagnostic and Interventional Radiology: An Integrative Review of Recent Literature
DOI:
https://doi.org/10.15392/2319-0612.2025.2802Keywords:
tissue reaction , deterministic effects, ionizing radiationAbstract
Ninety-eight percent of the global average individual dose delivered by artificial sources of ionizing radiation results from their use in medical applications, especially for diagnostic and interventional purposes. Although the benefits of radiation in medicine are widely recognized, exposure to this agent can cause harmful effects on the health of exposed individuals. Radiation applications for diagnostic purposes are generally associated with low doses, but interventional procedures may involve much higher doses. In the 2000s and 2010s, several publications described tissue reactions in patients and professionals exposed during interventional radiological procedures. This work aimed to review the literature on the most recent reports (last decade) on the occurrence of tissue reactions after diagnostic or interventional radiological procedures. The PubMed search tool was used to search and select publications on the topic. Although 826 articles were initially selected, only 5 presented relevant content for this review. The low number of articles in the final selection may be a result of the methodology we used or an actual reduction in the number of individuals presenting these effects in more recent years, due to the growing concerns about radiological protection in these practices. Among the articles analyzed, there were reports of skin lesions, as well as thinning or hair loss in patients exposed to doses (cumulative air kerma at the reference point) above 3.5 Gy. However, these reactions are rare and do not appear in most patients, even among those who received higher doses. An increased frequency of lens opacities (cataracts) has also been reported in occupationally exposed professionals. An adequate assessment of the occurrence of these effects is essential to try to understand their causes and minimize the frequency or consequences of their occurrence. Carrying out research like this can help with this task.
Downloads
References
[1] UNSCEAR. UNSCEAR 2008 Report on Sources and Effects of Ionizing Radiation. Vol. 1, United Nations Scientific Committee on the Effects of Atomic Radiation, United Nations. 2008.
[2] BALTER, S.; HOPEWELL, J.W.; MILLER, D.L.; WAGNER, L.K.; ZELEFSKY, M.J. Fluoroscopically guided interventional procedures: A review of radiation effects on patients’ skin and hair, v. 254, Radiology, 2010. DOI: https://doi.org/10.1148/radiol.2542082312
[3] ICRP. ICRP Publication 85: Avoidance of Radiation Injuries from Medical Interventional Procedures. Ann ICRP, v. 2, p. 30, 2000. DOI: https://doi.org/10.1016/S0146-6453(01)00004-5
[4] IAEA. Safety in Fluoroscopy Guided Interventional Procedures. https://www.iaea.org/resources/rpop/resources/safety-in-fgi-procedures.
[5] IAEA. Quality assurance and Optimization for Fluoroscopically Guided Interventional procedures. IAEA Human Health Series No. 48 [IAEA Preprint]. https://preprint.iaea.org/search.aspx?orig_q=reportnumber:IAEA-PC--9027, 2024.
[6] CORRIGALL, R.S.; MARTIN, C.J.; SCOTT, I. Observations of tissue reactions following neuroradiology interventional procedures. Journal of Radiological Protection, v. 1, p. 40, 2020. DOI: https://doi.org/10.1088/1361-6498/ab5bf4
[7] PERRY, B.C.; INGRAHAM, C.R.; STEWART, B.K.; VALJI, K.; KANAL, K.M. Monitoring and Follow-Up of High Radiation Dose Cases in Interventional Radiology. Acad Radiol, v. 2, p. 26, 2019. DOI: https://doi.org/10.1016/j.acra.2018.04.020
[8] KIRKWOOD, M.L.; ARBIQUE, G.M.; GUILD, J.B.; TIMARAN, C.; ANDERSON, J.A.; VALENTINE, R.J. Deterministic effects after fenestrated endovascular aortic aneurysm repair. Journal of Vascular Surgery. 2015. DOI: https://doi.org/10.1016/j.jvs.2014.11.044
[9] KIRKWOOD, M.L.; ARBIQUE, G.M.; GUILD, J.B.; TIMARAN, C.; VALENTINE, R.J.; ANDERSON, J.A. Radiation-induced skin injury after complex endovascular procedures. Journal of Vascular Surgery, 2014. DOI: https://doi.org/10.1016/j.jvs.2014.03.236
[10] Barbosa AHP, Medeiros RB, Corpa AMR, Higa FS, de Souza MT, Barbosa PL, et al. Prevalence of lens opacity in interventional cardiologists and professional working in the hemodynamics in Brazil. Arq Bras Cardiol, v. 4, p. 112, 2019. DOI: https://doi.org/10.5935/abc.20190028
[11] IEC - International Electrotechnical Commission (2000) report 60601. Medical electrical equipment – Part 2-43: particular requirements for the safety of x-ray equipment for interventional procedures. International Electrotechnical Commission, Geneva.
[12] BALTER, S. “Methods for measuring fluoroscopic skin dose”. Pediatr Radiol (2006) 36 (Suppl 2): 136–140. DOI: https://doi.org/10.1007/s00247-006-0193-3
[13] SHORE, R.E. Radiation and cataract risk: Impact of recent epidemiologic studies on ICRP judgments. Mutat Res Rev Mutat Res., 2016. DOI: https://doi.org/10.1016/j.mrrev.2016.06.006
[14] AINSBURY, E.A.; DALKE, C.; HAMADA, N.; BENADJAOUD, M.A.; CHUMAK, V.; GINJAUME, M.; et al. Radiation-induced lens opacities: Epidemiological, clinical and experimental evidence, methodological issues, research gaps and strategy. Environ Int., 2021. DOI: https://doi.org/10.1016/j.envint.2020.106213
[15] ICRP. ICRP Publication 118: ICRP Statement on Tissue Reactions and Early and Late Effects of Radiation in Normal Tissues and Organs - Threshold Doses for Tissue Reactions in a Radiation Protection Context. Ann ICRP, v. 41, p. 1-2, 2012. DOI: https://doi.org/10.1016/j.icrp.2012.02.001
[16] ASARI, T.; ROKUNOHE, D.; SASAKI, E.; KANEKO, T.; KUMAGAI, G.; WADA, K.; et al. Occupational ionizing radiation-induced skin injury among orthopedic surgeons: A clinical survey. Journal of Orthopaedic Science, v. 1, p. 27, 2022. DOI: https://doi.org/10.1016/j.jos.2020.11.008
[17] LIM, Y.; BYUN, H.J.; PARK, C.S.; LEE, J.H.; PARK, J.H.; et al. Primary cutaneous carcinosarcoma developing after chronic C-arm radiation exposure. JAAD Case Rep., v. 2, p. 4, 2018. DOI: https://doi.org/10.1016/j.jdcr.2017.07.024
[18] BOGDANICH, W. Radiation Overdoses Point Up Dangers of CT Scans. The New York Times, 2009.
[19] IAEA - Safety in Radiological Procedures (SAFRAD). https://www.iaea.org/resources/rpop/resources/databases-and-learning-systems/safrad
[20] IAEA. ISEMIR-IC: Interventional Cardiology. https://www.iaea.org/resources/rpop/resources/databases-and-learning-systems/isemir-icIAEA.
Published
Issue
Section
License
Copyright (c) 2025 Laisa Neves, Lucía Canevaro Lucía Viviana Canevaro, Ana Dovales Ana Cristina Murta Dovales
This work is licensed under a Creative Commons Attribution 4.0 International License.
Licensing: The BJRS articles are licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/
How to Cite
