UMMS Affiliation

Department of Surgery; Department of Radiation Oncology

Publication Date


Document Type



Neoplasms | Oncology | Radiation Medicine | Radiology | Skin and Connective Tissue Diseases | Surgery | Surgical Procedures, Operative | Therapeutics


Introduction: Radiation therapy is crucial to effective cancer treatment. Modern treatment strategies have reduced possible skin injury, but few clinical studies have addressed the dose relationship between radiation exposure and skin reaction. This prospective clinical study analyzes skin oxygenation/perfusion in patients undergoing fractionated breast conserving therapy via hyperspectral imaging (HSI).

Methods: Forty-three women undergoing breast conserving therapy were enrolled in this study. Optically stimulated luminescent dosimeters (OSLDs) measured radiation exposure in four sites: treatment breast, lumpectomy scar, medial tattoo and the control breast. The oxygenation/perfusion states of these sites were prospectively imaged before and after each treatment fraction with HSI. Visual skin reactions were classified according to the RTOG system.

Results: 2753 observations were obtained and indicated a dose-response relationship between radiation exposure and oxygenated hemoglobin (OxyHb) after a 600 cGy cumulative dose threshold. There was a relatively weak association between DeoxyHb and radiation exposure. Results suggest strong correlations between changes in mean OxyHb and skin reaction as well as between radiation exposure and changes in skin reaction.

Conclusion: HSI demonstrates promise in the assessment of skin dose as well as an objective measure of skin reaction. The ability to easily identify adverse skin reactions and to modify the treatment plan may circumvent the need for detrimental treatment breaks.


Breast cancer, Hyperspectral imaging, Oxygenation, Perfusion, Radiodermatitis, Skin injury

Rights and Permissions

Copyright 2017: The Authors. Published by Elsevier Ireland Ltd on behalf of European Society for Radiotherapy and Oncology. This is an open access article under the CC BY-NC-ND license (

DOI of Published Version



Chin MS, Siegel-Reamer L, FitzGerald GA, Wyman A, Connor NM, Lo YC, Sioshansi S, Moni J, Giulia Cicchetti M, Lalikos JF, FitzGerald TJ. Association between cumulative radiation dose, adverse skin reactions, and changes in surface hemoglobin among women undergoing breast conserving therapy. Clin Transl Radiat Oncol. 2017 May 18;4:15-23. doi: 10.1016/j.ctro.2017.03.003. PMID: 29594203; PMCID: PMC5833900. Link to article on publisher's site

Journal/Book/Conference Title

Clinical and translational radiation oncology

Related Resources

Link to Article in PubMed

PubMed ID


Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.