RISR assessments: A look at skin tone considerations in radiation therapist assessments in Canada.

Authors

Jacqueline M Middleton, Macy Kwan, Jasmine Li, Harsimran Sidhu, Annika Tam, Cynthia Palmaria

Published in

Journal of medical imaging and radiation sciences. Volume 57. Issue 6. Pages 102565. Aug 22, 2026. Epub Aug 22, 2026.

Abstract

Radiation dermatitis or radiation-induced skin reaction (RISR) is a common side effect of external beam radiation therapy. RISR presents differently across skin tones, yet existing grading tools describe the signs of RISR typical of those seen in white skin. This study gathered information about RISR grading tool use and radiation therapists' (RTs') confidence in identifying, managing and teaching about RISR across all skin tones.
An electronic survey was distributed to all radiation therapy departments in Canada. RTs working in roles with direct patient contact were invited to participate. The survey gathered information about RISR grading tools currently used, confidence levels in performing RISR assessments and care across the skin tone range, perceptions of sufficiency of RISR resources, and RISR education. Skin tones were defined using the Self-Assessment of Skin Tone Palette, which categorizes skin tones as A1-C3. Subcategories of A1-B1 and B2-C3 were used to represent lighter versus darker skin tones, respectively. Data were analyzed using descriptive statistics. Comparisons between confidence scores were analyzed using the Wilcoxon signed-rank test and Sign tests. An inductive content-analysis approach was used for analysis of open-ended question responses.
A total of 67 surveys were completed. Results showed variation in awareness and use of established grading tools. No respondents indicated the use of grading tools specific to the B2-C3 skin tones. RTs reported lower confidence in identifying, managing, and educating about RISRs in patients with B2-C3 tones compared to A1-B1. Opinion was split on whether current RISR resources are sufficient. Seventy-three percent expressed interest in further education on RISRs in all skin tones.
RISR assessment practices vary across radiation therapy departments and between RTs. Decreased confidence in RISR assessment in darker skin may indicate insufficiency of current grading tools and prior education. Future work needs to address the skin tone inclusivity of grading tools and ensure educational materials are more reflective of the diversity of our patient population.
Skin reactions are a common side effect of radiation therapy, but they can look different on different skin tones. This study surveyed radiation therapists across Canada about how they assess and manage radiation-related skin reactions and how confident they feel doing so across a range of skin tones. This study found that radiation therapists were less confident identifying, managing, and teaching about skin reactions in people with darker skin tones, and many wanted more education on this topic. This matters because improving assessment tools and training could help ensure that people of all skin tones receive high-quality and equitable care during radiation therapy.

PMID:
42632306
Bibliographic data and abstract were imported from PubMed on 23 Aug 2026.

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