Limiting tattoos and marks

1. David Cameron, MS DABR

2.  None

3.  Head of Physics for Hannleb Medical Physics
 Lead Physicist for ROCC
 Matthews Radiation Oncology Center
 Lake Norman Radiation Oncology Center
 Both sites use align RT

4. • Lung
• Breast
• Abdomen
• Extremities
• Bone Mets
• Sarcomas
• Liposarcoma
• Extremities

5.  Commissioning done in accordance with TG147.
 Test include
 Integration of Peripheral Equipment
 Communication w/ R &V, Linac Integration, Localization of
FOV
 Spatial Reproducibility and Drift
 Static localization
 E2E, Displacement Accuracy
 Dynamic Localization Accuracy
 Spatial, Temporal, and Dynamic Radiation Delivery
 Vendor Recommendations
 Documentation
 SOPs

6. Limiting the Marks
 E2E tests on a series of
phantoms was performed
 Scan unique phantoms
 “unique” being a
phantom with an
adequate contour
 Solid water with Foam
head rest
 Set up phantom to dicom
 Image to verify position
 Perform offsets and
angular changes
 Verify dose delivered

10.  Set up to free breathing body contour to
remove any large rotational and translation
values
 Switch to DIBH body contour and make fine
adjustments
 Audio command to call in breathing
instructions
 Port a verify Tangential iso.
 Reference capture if necessary

12.  Patients are indexed to longitudinal position
 Align RT is turned on for setup.
 Rotational values are adjusted first, then
translational values to within tolerance
 Upon isocenter verification via port films, iso
marks are placed on patient for reference
 Medial border mark or SSD daily has been discussed in
clinic for breast patients
 Field light photos captured to place in patients
chart

13.  First day of treatment: Set up patient using
ROI generated on DICOM surface image.
 Image patient
 Capture new reference image if iso shift has
been approved by physician (if necessary)
 Following treatments: Set up to latest reference
image and spot check iso mark.

14.  Recently started implementing Align RT for set
up of multiple iso treatments for bone mets
 Advantages
 Validates appropriate treatment site
 Smaller shifts due to ability to eliminate large
rotations
 Field light photos instead of marks

15. - Patients
- No longer have to conceal marks from others
- Marks fade onto clothing
- Tattoos are for a lifetime
- Visual reminder of their treatment
- No chance for needles sticks– increase safety
- Efficiency
- Cut down patient time
- Patient time being when they get called back for treatment to the time they leave
the treatment room
- No more drawing on field borders
- Quicker set ups for multi iso setups without compromising safety
- Cost
- Paint pens and tapes usage decreased
- Accuracy and Safety
- More information
- Patient contour and ROI results more information for setup vs 3 point system

18.  Buying in
 Habit
 Comfort with the system
 Eliminating the on surface visual reassurance

19.  E2E testing
 Prove it to yourself it is accurate
 Don’t remove all marks at once
 We started by removing field and border marks.
Decided to keep a single iso marks as a quick
reference