A randomized control trial evaluating fluorescent ink $\textit{versus}$ dark ink tattoos for breast radiotherapy

Change log
Landeg, SJ 
Kirby, AM 
Lee, SF 
Bartlett, F 
Titmarsh, K 

Objective: The purpose of this UK study was to evaluate interfraction 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 with conventional dark ink.

Methods: In this non-blinded, single-centre, parallel group, randomized control trial, patients were allocated to receive either conventional dark ink or UV ink tattoos using computer-generated random blocks. Participant assignment was not masked. Systematic () and random (σ) setup errors were determined using electronic portal images. Body image questionnaires were completed at pre-treatment, 1 month and 6 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. <2.8 mm.

Results: 46 patients were randomized to receive conventional dark or UV ink tattoos. 45 patients completed treatment (UV: n = 23, dark: n = 22). σsetup for the UV tattoo group was <2.8 mm in the u and v directions (p = 0.001 and p = 0.009, respectively). A larger proportion of patients reported improvement in body image score in the UV tattoo group compared with the dark ink group at 1 month [56% (13/23) vs 14% (3/22), respectively] and 6 months [52% (11/21) vs 38% (8/21), respectively].

Conclusion: UV tattoos were associated with interfraction setup reproducibility comparable with conventional dark ink. Patients reported a more favourable change in body image score up to 6 months following treatment.

Advances in knowledge: This study is the first to evaluate UV tattoo external references in a randomized control trial.

Breast Neoplasms, Female, Fluorescence, Humans, Ink, Middle Aged, Reproducibility of Results, Tattooing, United Kingdom
Journal Title
The British Journal of Radiology
Conference Name
Journal ISSN
Volume Title
The British Institute of Radiology
This work was supported by the Institute of Cancer Research (ICR) and Cancer Research UK grant numbers C46/A3970 and C33589/ A19727 to the ICR Section of Radiotherapy. We acknowledge NHS funding to the National Institute for Health Research (NIHR) Biomedical Research Centre at The Royal Marsden and the ICR. Ellen Donovan is supported by the National Institute for Health Research via a Career Development Fellowship (CDF-2013-06- 005). We would like to thank the Royal Society for the University Research Fellowship of Steven Frank Lee (UF120277).