Radiotherapy without tattoos: Could this work?

Radiography (Lond). 2020 Nov;26(4):288-293. doi: 10.1016/j.radi.2020.02.008. Epub 2020 Mar 31.


Introduction: An evaluation to compare the traditional tattoo based set up procedure with a surface guided method to assess the possibility of eliminating permanent tattoos in breast cancer patents who are undergoing radiotherapy to the breast/chest wall.

Methods: Forty-three patients that were having radiotherapy to the breast or chest wall were included in this evaluation. The patients were divided into two groups and further divided into 2 sub-groups. The first group received standard dark ink tattoos and were positioned by aligning these tattoos with lasers. The second group had no tattoo's and were positioned using the Surface-Guided technology (SGRT). Within each group the patients were split into 2 sub-group; right and left sided treatment areas. The right side were treated using a Free-Breathing (FB) technique and the left sided were treated using a Deep-Inspiration Breath-Hold (DIBH) technique.

Results: For the patients having right sided breast radiotherapy, the mean shift using the standard tattoos and laser set up was 0.52 cm, compared with using the SGRT method where the mean shift was 0.47 cm. (p-value 0.04) For patients having left sided breast radiotherapy with DIBH the mean shift using the standard tattoo's and laser set up was 0.76 cm, compared with a mean shift of 0.45 cm using SGRT alone (p-value < 0.001).

Conclusion: The elimination of tattoos together with SGRT offers a comparable set-up for right sided breast treatments against the traditional tattoo method. A significant set-up improvement was observed for the left sided breast DIBH treatments.

Implications for practice: To set up patients having breast Radiotherapy, with no tattoo's.

Keywords: AlignRT; DIBH; IGRT; Radiotherapy; SGRT; Tattooless.

MeSH terms

  • Breast Neoplasms* / radiotherapy
  • Breath Holding
  • Female
  • Humans
  • Radiotherapy Dosage
  • Radiotherapy Planning, Computer-Assisted
  • Tattooing*