Radiotherapy set-up without permanent ink tattoos, using surface guidance or invisible ink

The harm being removed. Radiotherapy alignment tattoos are permanent dots of Indian ink about 2 millimetres across. In a survey distributed by Breast Cancer Now to people who had had breast radiotherapy, all 204 respondents had them and 95 per cent could still see the midline dot. Twenty-seven per cent described them as a constant negative reminder, 14 per cent said they affected clothing choices and 11 per cent said they hated them; overall impact was scored negative for 51 per cent, neutral for 43 and positive for 6. The authors call for alternatives that are accessible for people of all skin colours.

The alternatives. A systematic review of 13 studies found that surface-guided set-up for free-breathing breast radiotherapy was at least as accurate and reproducible as tattoos and lasers, with consistently smaller residual errors and better efficiency, and could reduce the number of routine imaging exposures. Where surface guidance is not available, a randomised trial of 34 women found ultraviolet-ink tattoos, invisible in daylight, gave set-up errors no different from dark ink with almost no effect on set-up time.

The question is not whether tattoo-free set-up can be done, which the review answers, but whether departments that already have surface cameras for breath-hold have switched. No survey OnCo found measures that.