2018 SGRT Community Meeting Atlanta
- 1. Presented by Joanne Rigley, Deputy Lead Radiographer, Genesis Care Nottingham, UK To Evaluate the Accuracy of Delivering Breast Radiotherapy without Tattoos
- 2. Page 2
- 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 Page 3 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 Page 4 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. Page 5 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. Page 7 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. Page 8 Results
- 10. Page 10 Results
- 11. Page 11 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
- 12. Page 12 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.