Tattoo and mark-free treatments


In June 2021, UHDB were looking for a Surface Guided Radiation Therapy (SGRT) solution to replace their RPM system, which they were using for Deep Inspiration Breath-hold (DIBH) treatments. After a lengthy evaluation of available options, they decided AlignRT from Vision RT would be the best fit. Soon, they set an ambitious goal for their new system: to offer tattoo and mark-free treatments from the first day of its use. They made this decision with their patients’ needs in mind: “we didn’t want to be that site that still tattooed patients, as a ‘comfort blanket’ but didn’t use [those tattoos]. We didn’t think this was fair or ethical for the patient.”

Consultative Meetings

Vision RT offers a three-phase training approach, but pre-training consultative meetings are held with the Clinical Applications Specialist (CAS) prior to the official start of training. This enables a fully collaborative approach to implementation. There were several pre-training meetings between Vision RT and UHDB to discuss how to meet their needs and expectations. The CAS looked at how to get the best out of Vision RT’s training and which elements were most important to them at the point of go-live.

UHDB’s CAS faced several challenges. The first was the ‘fear factor.’ Some staff members, having never been part of a center offering tattoo-free treatments, were sceptical it could be done within existing workflows. Others were reticent to alter long-existing workflows. The objective of going tattoo-free could only be met if the entire team could be shown that Vision RT’s systems offered a safe and effective way of working – and one that didn’t replace existing routines with more complexity.

Phase 1

Armed with the knowledge from these consultative meetings, the CAS provided the site with a list of actions to complete prior to the Phase 1 training. One task required them to scan an anatomically correct full-skeleton phantom (fondly named Colin) and create multiple treatment plans.

Immediately after this, Phase 1 was delivered on-site over two separate sessions. A multi-disciplinary team of roughly 14 attended. Each day was split into two sections. The first half was theory and the second, practical.

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Phase 2

This phase of the project allowed the clinic to consolidate their learning and gave them time to write new protocols. It was supplemented with e-learning, via Vision RT’s online training portal. Support was also provided by the CAS who ran supplemental training for staff that had missed Vision RT’s Phase 1 training, and included help with reviewing Regions of Interest (ROIs) as well as proof-reading protocols. All these steps ensured UHDB’s workflows would be accommodated and optimized when the new AlignRT system was launched.

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Phase 3

The same CAS who had been working with the team throughout the entire project, supported the go-live over a two-day window in mid-July. They made sure that their most experienced users would be on hand the entire time, to ensure consistency across every workflow. All of the team’s hard work, training and preparation soon proved effective, as every project objective was met at go-live.

A new tattoo and mark-free treatment was delivered and has been offered at the hospital since.

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Hear from our users

“We’re extremely pleased to now be able to offer Surface Guided Radiotherapy, which has had a great impact on treatment times for our patients. With this system, we have a lot more control over where the patient is lying, which makes it a lot easier for us to get them in exactly the right position, which is crucial for their treatment."

Dave Pilborough

Superintendent Radiographer

“From the feedback we’ve received since we introduced this new technique in the summer, being able to have this treatment tattoo-free has been a source of great comfort to our patients and helped them to feel a bit less anxious, before starting treatment. It is fantastic that we’ve been able to enhance patient experience in this way, whilst also offering an advanced radiotherapy technique that is even more accurate than before and which can reduce the length of treatment too.”

Dr Magnus Harrison

Executive Medical Director at UHDB

Follow Up

By the end of 2021, as their experience and confidence increased, UHDB expanded their use of SGRT with AlignRT to all breast, DIBH, lung and lung SABR treatments. They are now in the process of rolling it out for oligometastatic SABR (SBRT) treatments.

Learn more

10 ways SGRT with AlignRT can help your clinical practice

Get in touch

Vision RT’s family of SGRT solutions guide radiation therapy for better patient care at every step: sim, planning and treatment.

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