In our department several of the senior interventional cardiologists have noticed the onset of hair loss affecting both lower limbs. The panel here shows, from left to right, a junior cardiologist and two senior interventional cardiologists with pronounced atypical hair loss.
Dermatological advice suggested that the appearances are consistent with chronic occupational radiodermatitis.
Cardiac angiography is known to produce one of the largest radiation exposures of any diagnostic x ray procedure.
Chronic occupational dermatitis initially causes the skin to become dry, shiny and hairless, with atrophy of the epidermis. Ulceration, fibrosis, and eventual squamous cell carcinoma may develop. The cumulative radiation dose necessary to induce chronic changes is above 10–12 Gy. For comparison, a patient may receive up to 6 Gy during a prolonged coronary angioplasty.
It is standard practice to wear lead aprons, glasses, and thyroid collars. Interestingly cardiologists’ hands receive the highest radiation exposure as they are closest to the source, yet hand protection is seldom worn. The lower legs also receive considerable scatter radiation.
It is now standard practice in our department to wear lead shielding around the lower legs.
Figure 1.
No competing interests declared