Iranian Journal of Medical Physics

Iranian Journal of Medical Physics

Investigation of Erythema, Radiation Dose, and Radiation-Induced Apoptosis in the Peripheral Blood Lymphocytes of Patients Treated with Radiofrequency Catheter Ablation

Document Type : Original Paper

Authors
Gholamhassan Haddadi 1
Hadiseh Alimoradi 2
Reza Fardid 2
Tahereh Zare 2
Mohammad Vahid Jorat 3
1 Department of Radiology, School of Paramedical Sciences, Shiraz University of medical Sciences, Shiraz, Iran
2 Department of Radiology, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
3 Shiraz University of Medical Sciences, Shiraz, Iran
10.22038/ijmp.2019.37682.1480
Abstract
Introduction: The long-term use of fluoroscopy in cardiac interventional procedures increases the patient dose and causes severe skin reactions, which lead to growing concern. The aim of the present study was to evaluate the risk and the effect of X-ray irradiation on apoptosis in the peripheral blood lymphocytes of patients treated with ablation in electrophysiological studies.
Material and Methods: A total of 30 patients who underwent ablation therapy participated in this study. The absorbed dose in the given area was measured by a thermos luminescent dosimeter (TLD). The duration of dose delivery, absorbed dose by the apparatus, and dose area product (DAP) factor were measured for each patient. The skin changes were observed within the 1st day to 5th week after the operation. Blood sampling was conducted (before and 24 h after the treatment), and then, flow cytometry was performed to investigate the apoptotic changes in the blood lymphocytes.
Results: The statistical analysis showed that there was a significant difference in the apoptosis of patient blood lymphocytes before irradiation and following that (p <0.05). There was a correlation between the amount of DAP and TLD dose (p <0.001). Furthermore, a correlation was observed between the total apoptosis and fluoroscopic time. The patient radiation dose in the ablation test was not in the threshold level required to create skin erythema.
Conclusion: The results of the present study revealed that the use of long-time fluoroscopy in electrophysiological studies may cause a significant increase of apoptosis in the peripheral blood lymphocyte of patients treated using this procedure.
Keywords
Ionizing Radiation
Skin Injury
Apoptosis
Interventional Radiology
Subjects
  1. Bor D, Olğar T, Toklu T, Çağlan A, Önal E, Padovani R. Patient doses and dosimetric evaluations in interventional cardiology. Physica Medica: European Journal of Medical Physics. 2009; 25(1): 31-42.
  2. Faithfull S, Wells M. Supportive care in radiotherapy: Elsevier Health Sciences; 2003.
  3. Koenig TR, Wolff D, Mettler FA, Wagner LK. Skin injuries from fluoroscopically guided procedures: part 1, characteristics of radiation injury. American journal of roentgenology. 2001; 177(1): 3-11.
  4. Ryan JL. Ionizing radiation: the good, the bad, and the ugly. Journal of Investigative Dermatology. 2012; 132(3): 985-93.
  5. Efstathopoulos EP, Katritsis DG, Kottou S, Kalivas N, Tzanalaridou E, Giazitzoglou E, et al. Patient and staff radiation dosimetry during cardiac electrophysiology studies and catheter ablation procedures: a comprehensive analysis. Europace. 2006; 8(6): 443-8.
  6. McQuestion M, editor Evidence-based skin care management in radiation therapy. Seminars in Oncology Nursing. 2006.
  7. Wagner L. Radiation injury is a potentially serious complication to fluoroscopically-guided complex interventions. Biomedical imaging and intervention journal. 2007; 3(2).
  8. Geleijns J, Wondergem J. X-ray imaging and the skin: radiation biology, patient dosimetry and observed effects. Radiation protection dosimetry. 2005; 114(1-3): 121-5.
  9. Waghmare CM. Radiation burn—from mechanism to management. Burns. 2013; 39(2): 212-9.
  10. Shope TB. Radiation-induced skin injuries from fluoroscopy. Radiographics. 1996; 16(5): 1195-9.
  11. Miller DL, Balter S, Noonan PT, Georgia JD. Minimizing radiation-induced skin injury in interventional radiology procedures. Radiology. 2002; 225(2): 329-36.
  12. Tavakkoli MB , Kheirollahi M, Kazemi M, Mohebat L, Haghjooy Javanmard SH, Roayae M. Evaluation of Measuring Radiation-Induced Apoptosis in Human T-Lymphocytes by Flow Cytometry as a Biological Dosimetry System (In Persian). J Isfahan Med Sch. 2014; 32(284): 610-20.
  13. McParland B. Entrance skin dose estimates derived from dose-area product measurements in interventional radiological procedures. The British journal of radiology. 1998; 71(852): 1288-95.
  14. Faulkner K, Vano A, Ortiz P, Ruiz R, editors. Practical aspects of radiation protection in interventional radiology. The 10th International Congress of the International Radiation Protection Association Hiroshima, Japan: The International Radiation Protection Association; 2000.
  15. Karimizarchi H, Chaparian A. Estimating risk of exposure induced cancer death in patients undergoing computed tomography pulmonary angiography. Radioprotection. 2017; 52(2): 81-6.
  16. Chaparian A, Zarchi HK. Assessment of radiation-induced cancer risk to patients undergoing computed tomography angiography scans. International Journal of Radiation Research. 2018; 16(1): 107-15.
  17. Seguchi S, Aoyama T, Koyama S, Kawaura C, Fujii K. Evaluation of exposure dose to patients undergoing catheter ablation procedures—a phantom study. European radiology. 2008; 18(11): 2559-67.
  18. Tavakoli M, Monsef S, Hashemi M, Emami H. Assessment of patients skin dose undergoing coronary angiography and Percutaneous Transluminal Coronary Angioplasty (PTCA). 2010.
  19. Widmark A, Hellesnes J, editors. Acute radiation injury after percutaneous transluminal coronary angioplasty (PTCA): a case report. Joint WHO/ISH Workshop on Efficacy and Radiation Safety in Interventional Radiology; 1995.
  20. Quai E, Padovani R, Peterzol A, Vano E, Guibelalde E, Toivonen M. Maximum skin dose assessment in interventional cardiology: results in three different European hospitals. 2003.
  21. Chida K, Saito H, Otani H, Kohzuki M, Takahashi S, Yamada S, et al. Relationship between fluoroscopic time, dose–area product, body weight, and maximum radiation skin dose in cardiac interventional procedures. American Journal of roentgenology. 2006; 186(3): 774-8.
  22. Van De Putte S, Verhaegen F, Taeymans Y, Thierens H. Correlation of patient skin doses in cardiac interventional radiology with dose-area product. The British journal of radiology. 2000;
  23. Tsapaki V, Kottou S, Vano E, Faulkner K, Giannouleas J, Padovani R, et al. Patient dose values in a dedicated Greek cardiac centre. The British journal of radiology. 2003; 76(910): 726-30.
  24. Kuon E, Dahm J, Schmitt M, Glaser C, Gefeller O, Pfahlberg A. Time of day influences patient radiation exposure from percutaneous cardiac interventions. The British journal of radiology. 2003; 76(903): 189-91.
  25. Kuon E, Glaser C, Dahm J. Effective techniques for reduction of radiation dosage to patients undergoing invasive cardiac procedures. The British journal of radiology. 2003; 76(906): 406-13.
  26. Padovani R, Bernardi G, Malisan M, Vano E, Morocutti G, Fioretti P. Patient dose related to the complexity of interventional cardiology procedures. Radiation protection dosimetry. 2001; 94(1-2): 189-92.

 

 

 

Iranian Journal of Medical Physics
Volume 18, Issue 1
January and February 2021
Pages 15-22

  • Receive Date 15 February 2019
  • Revise Date 07 October 2019
  • Accept Date 26 November 2019