To evaluate the accuracy of delivering breast radiotherapy without tattoos

1. Presented by Joanne Rigley, Deputy Lead Radiographer,
Genesis Care Nottingham, UK
To Evaluate the Accuracy of Delivering
Breast Radiotherapy without Tattoos

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3. • During radiotherapy breast cancer patients are
traditionally set-up using permanent tattoos.
• Tattoos have a significant impact on body confidence and
self-esteem due to where the tattoos are positioned.
• Tattoos are a reminder of Cancer diagnosis and treatment.
• Patients may refuse tattoos due to religious or cultural
beliefs.
• Potential risk for needle stick injury to health professional.
• AlignRT installed November 2016- showed a practical
alternative to tattoo’s
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Background

4. • The purpose of this study was to assess
the feasibility of having no tattoos and
using Surface Guided Radiotherapy
(SGRT) (Vision RT, London UK) as an
alternative to the traditional tattoo
based set-up method
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Purpose

5. • 43 patients receiving whole breast/chest wall
Radiotherapy were included in this evaluation.
• All patients were positioned on a C-Qual breast
board (CIVCO Medical Solutions) with one arm above
the head, immobilised with the customised cradles.
• The first group (22 patients) received two standard
dark ink tattoos, and were positioned aligning the
tattoos with a measured point on the breast board,
with lasers.
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Method

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Method

7. • The second group (21 patients)had no
tattoos, and positioned using SGRT, Align RT
(Vision RT, London, UK).
• A daily 3D-CBCT was completed for each
patient for both groups, reviewed and
matched online. The longitudinal, lateral
and vertical shifts determined from the
online match were recorded and analysed.
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Method

8. • Within each group the data was divided between left
and right sided breasts, as the left breast patients were
treated under Deep Inspiration Breath Hold (DIBH) and
the right breast patients were treated in free breathing.
• All three translational shifts (longitudinal, lateral, vertical)
and the 3D vector magnitude were then plotted on
graphs.
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Results

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Results

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Results

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Results
Table showing tabulated values for all three translations for both set up
methods
Mean (cm Min (cm) Max (cm) SD Rt Mean (cm) Min (cm) Max (cm) SD
Sup-Inf 0.2 0.0 0.8 0.2 Sup-Inf 0.2 0 1.2 0.2
Lt-Rt 0.2 0.0 0.9 0.2 Lt-Rt 0.2 0 1.4 0.2
Ant-Post 0.3 0.0 1.3 0.3 Ant-Post 0.3 0 0.8 0.2
3DMag 0.5 0.1 1.4 0.3 3DMag 0.5 0.1 1.9 0.2
Sup-Inf 0.3 0.0 1.2 0.2 Lt Sup-Inf 0.2 0 1.2 0.2
Lt-Rt 0.3 0.0 1.5 0.3 Lt-Rt 0.2 0 0.6 0.1
Ant-Post 0.5 0.0 3.5 0.5 Ant-Post 0.3 0 1 0.2
3DMag 0.8 0.1 3.6 0.5 3DMag 0.4 0.1 1.4 0.2
Laser SGRT
RT
Lt

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Conclusion
• SGRT offers set up accuracy for right breast set-up
comparable to that of the traditional method.
• SGRT offers a significant improvement for the left breast
DIBH patients.
• With our current imaging regime, this work shows that
going tattoo-less is appropriate and safe.
• Improve patient experience of having breast
Radiotherapy by addressing the cosmetic and
psychological concerns associated with dark ink tattoos.