Eliminating tattoos for short course palliative radiation therapy: Set-up error, satisfaction and cost

Area of Science:

• Radiation Oncology
• Medical Physics

Background:

• Advancements in palliative care and radiotherapy have increased patient longevity.
• Permanent ink tattoos were historically used for radiotherapy setup accuracy but caused patient distress.
• Image-guided radiation therapy (IGRT) is now standard, potentially negating the need for permanent markers.

Purpose of the Study:

• To evaluate the efficacy and safety of using Tegaderm™ dressings as a temporary skin marker alternative to permanent tattoos in palliative radiotherapy.
• To compare setup accuracy, patient outcomes, and costs between Tegaderm™ and tattoo methods.

Main Methods:

• A prospective study of 25 palliative patients receiving 5 fractions of radiotherapy using Tegaderm™ markers.
• Comparison of daily cone beam CT (CBCT) isocenter mismatch values with a historical cohort of 25 tattooed patients.
• Assessment of radiation therapist feedback, costs, and imaging requirements.

Main Results:

• Isocenter shifts were similar between Tegaderm™ and tattoo groups in AP and RL directions (p<0.05).
• A small, clinically insignificant increase in SI shift was observed with Tegaderm™ (p=0.01).
• No repeat CBCT or resimulations were needed; Tegaderm™ was substantially less costly and well-received by therapists, despite some durability concerns.

Conclusions:

• Tegaderm™ dressings are a safe and effective alternative to permanent tattoos for radiotherapy setup in palliative patients.
• This method does not increase setup time, error, or imaging needs, while significantly reducing costs and patient discomfort.
• IGRT integration supports the move away from invasive permanent skin marking techniques.