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Tattoo free setup for partial breast irradiation: A feasibility study.

Rachel B Jimenez1, Estelle Batin2, Drosoula Giantsoudi1

  • 1Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA.

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Permanent skin tattoos may not be necessary for accelerated partial breast irradiation (APBI) setup. Advanced imaging techniques like surface imaging and surgical clip matching offer comparable accuracy with reduced setup times, making tattoos potentially obsolete for APBI patients.

Keywords:
APBIbreast radiotherapysurface imagingtattoos

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Area of Science:

  • Radiation Oncology
  • Medical Imaging
  • Breast Cancer Treatment

Background:

  • Patients undergoing external beam accelerated partial breast irradiation (APBI) typically receive permanent skin tattoos for daily setup alignment.
  • The necessity of these tattoos is being re-evaluated with advancements in 3D body surface imaging and 2D x-ray imaging for surgical clip matching.

Purpose of the Study:

  • To compare the accuracy and efficiency of patient setup for APBI using conventional tattoos versus a tattoo-free approach utilizing surface imaging and surgical clip matching.

Main Methods:

  • Twenty APBI patients were divided into two groups: one using tattoos for initial positioning followed by surface imaging and clip matching, and another using only surface imaging and clip matching without tattoos.
  • Setup time and orthogonal x-ray shifts were recorded to calculate systematic and random errors for both groups.

Main Results:

  • The 'no tattoo' group demonstrated a significantly reduced average setup time per fraction (6.83 min vs. 8.03 min, P < 0.01).
  • Mean 3D vector shifts were comparable between groups (4.6 mm vs. 5.9 mm, P = NS).
  • Systematic and random errors were within acceptable ranges for both the tattoo and 'no tattoo' groups, with no statistically significant differences in overall accuracy.

Conclusions:

  • Surface imaging combined with 2D surgical clip matching provides accurate patient alignment and setup verification for APBI.
  • This tattoo-free approach significantly reduces setup time compared to traditional tattoo-based methods.
  • Skin-based tattoos may no longer be required for patients undergoing external beam APBI.