Radiation injury from x-ray exposure during brachytherapy localization

Two patients developed skin ulcers secondary to high doses of diagnostic-en ergy x rays received during localization procedures as part of brachytherap y treatments. Both were morbidly obese and diabetic. The obesity led to the delivery of estimated skin doses of 83 Cy in one case and 29 Gy in the oth er in attempts to produce readable images on localization radiographs. This report discusses the factors leading to the injuries, the progression of t he injuries over time, and the variables involved in the localization proce dures with the aim of preventing future mishaps. The greatest contribution to the large skin dose was the need, with the equipment available, to use m ultiple exposures to produce a single film, because of the effect of the re sultant reciprocity failure. (C) 2000 American Association of Physicists in Medicine. [S0094-2405(00)00807-5].