Tattoo-less chest wall and regional nodal irradiation using surface imaging

Area of Science:

• Radiation Oncology
• Medical Imaging
• Breast Cancer Treatment

Background:

• Traditional skin tattoos for radiotherapy setup can cause cosmetic issues and patient dissatisfaction.
• Advancements in surface imaging technology offer potential alternatives to tattoos.

Purpose of the Study:

• To compare the accuracy, time efficiency, and dosimetric parameters of tattoo-less setup using AlignRT (ART) versus traditional tattoo-based (TTB) techniques.
• To evaluate these methods in breast cancer patients requiring chest wall and regional nodal radiation.

Main Methods:

• A comparative study involving 49 breast cancer patients undergoing chest wall radiation.
• Patients received alternating daily setups using ART (tattoo-less) and TTB (tattoo-based).
• Setup accuracy (translational and rotational shifts) and time were recorded; dosimetry was calculated using the reverse isocenter shift technique.

Main Results:

• ART demonstrated significantly higher accuracy in translational shifts (TS) compared to TTB (p < 0.05 for all axes).
• ART also showed significantly greater accuracy in rotational shifts (RS) (p = 0.023), with no significant difference in precision for TS or RS.
• No significant differences were found in total in-room time or setup time between ART and TTB.

Conclusions:

• The tattoo-less setup with AlignRT (ART) is sufficiently accurate and efficient to potentially replace traditional tattoos for breast cancer radiotherapy.
• Further research with larger cohorts is recommended to confirm the complete replacement of tattoo-based approaches by surface imaging.