Hi all. I am in the process of moving our department to markerless for breast radiotherapy. How many people out there are completely mark and tattoo free? what were you biggest lessons in going through the process?
Thanks,
We are completely markless and love it! Have a game plan and think through possible problems ahead of time. We me with head of physics, dosimetry and our director to brainstorm how we would handle certain situations if they did arise (ex. system going down). We also went through a 3 month “trial run” where we agreed to keep marks as a back up. The trial was a success and we haven’t looked back since 
Tip: We make sure we index all of our patients and use tighter tolerance tables, even if we have to get creative. In addition to Vision RT we also can be confident we are in our correct position by in tolerance table parameters, checking medial light field and verifying medial SSD daily
We are also looking into going markerless, but have heard from other centres that they do still use measurements and pen marks, at least to get to a starting point. Our particular concern is regarding breasts, who are mostly treated on an incline, and although the breastboard is fixed, and the bumstop positioned, we still have to ask the patient to move up or down to get them at the correct point on the board. We have discussed measuring a point halfway between the ssn and xiphi to give us a starting point, but does anyone have any other solutions?
Do centres use pitch as the biggest indicator for patient positioning on the incline?
Any advice would be greatly appreciated, thanks
On the same thread, what contingency plans do other centres have in place if Align were to fail for any extended period, with markerless treatments?
Hi
One fresh article to this topic:
Eliminating Daily Shifts, Tattoos, and Skin Marks: Streamlining Isocenter Localization With Treatment Plan Embedded Couch Values for External Beam Radiation Therapy, Practical Radiation Oncology, Volume 9, Issue 1, January–February 2019, Pages e110-e117, Sueyoshi et. al.
Marko
We sometimes do have pitch issues and have to make adjustments but they correlate with what VisionRT is telling us. So, Do you use a vacloc for the arms on top of the breastboard?
In our clinic if the system were down, we would use our table parameters along with imaging and ssd checks for patient positioning. If we thought it might be down the next day then we would place marks and use them until the system came back up.
Hi, may I ask how do you check lateral border in SGRT?
Hi,
We have a rendered imaged uploaded and do a quick check of the border posistion on lateral and medial
We no longer check field borders as we have no reference mark to check with, however we have found that a combination of AlignRT and on treatment imaging confirms patient positioning. We do still check breast coverage with the light field before exiting in the room, including in breathold for our DIBH patients
Hi Marko, could you possibliy share the article with me? I do not have access to full article. very interested. thank you!
Is there a list with alle the departments who have a completly tattooless workflow for all their patiënts? Just curious hoe many departments allready made that Final step.
For a list of AlignRT customers who are tattoo and mark free, check out this website https://www.saferradiationtherapy.com/c … nt-center.
There are 132 centres worldwide that are tattoo and markfree for at least the breast cancer cases, with a significant amount of those having adopted tattoo and mark free across all indications for every patient every fraction. If you would like a more detailed list / number of those customers you can email me on mcreed@sgrt.org
Hi all, I am just wondering what imaging modality centers are using for tattooless breast patients. Thanks in advance