A randomised control trial evaluating fluorescent ink versus dark ink tattoos for breast radiotherapy.

Landeg, Steven J, Kirby, Anna M, Lee, Steven F, Bartlett, Freddie, Titmarsh, Kumud, Donovan, Ellen, Griffin, Clare L, Gothard, Lone, Locke, Imogen and McNair, Helen A (2016) A randomised control trial evaluating fluorescent ink versus dark ink tattoos for breast radiotherapy. British Journal of Radiology, 89(1068), p. 20160288. ISSN (print) 0007-1285


OBJECTIVES: The purpose of this UK study was to evaluate inter-fraction reproducibility and body image score when using Ultraviolet (UV) tattoos (not visible in ambient lighting) for external references during breast/chest wall radiotherapy and compare to conventional dark ink. METHODS: In this non-blinded, single centre, parallel group, randomised control trial, patients were allocated 1:1 to receive either conventional dark ink or UV ink tattoos using computer generated random blocks. Participant assignment was not masked. Systematic (∑) and random (σ) set-up errors were determined using electronic portal images (EPI). Body image questionnaires were completed at pre-treatment, one month and six months to determine the impact of tattoo type on body image. The primary end point was to determine that UV tattoo random error (σsetup) was no less accurate than with conventional dark ink tattoos, i.e < than 2.8 mm. RESULTS: Forty six patients were randomised to receive conventional dark or UV ink tattoos. 45 patients completed treatment (UV: n = 23, Dark: n = 22). σ setup for the UV tattoo group were less than 2.8 mm in the u and v directions (p 0.001; p 0.009 respectively). A larger proportion of patients reported improvement in body image score in the UV tattoo group compared to the dark ink group at one month (56% (13/23) vs 14% (3/22) respectively) and six months (52%(11/21) vs. 38% (8/21) respectively). CONCLUSIONS: UV tattoos were associated with comparable inter-fraction setup reproducibility to conventional dark ink. Patients reported more favorable change in body image score up to six months following treatment. Advances in knowledge: This study is the first to evaluate UV tattoo external references in a randomised control trial.

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