Abstract
Permanent tattoos are the standard for patient positioning in radiation therapy, but their permanence can negatively affect psychological well‑being and body image, particularly among breast cancer patients. This single‑centre feasibility study evaluated RadTat, a temporary skin marker, as an alternative to permanent tattoos for breast cancer radiation therapy in New Zealand.
A single-arm, non-randomised, open-label design was used to compare permanent tattoos with the RadTat workflow. Outcomes were assessed for marker durability, workflow efficiency, template positioning accuracy, patient experience, and cost. Twelve participants received both RadTats and standard permanent tattoos. The RadTat workflow was significantly longer than the permanent tattoo workflow, requiring an additional mean time of 3.2 minutes (SD = 1.1; 95% CI: 2.5–3.9; p<0.0001). Template‑to‑tattoo accuracy demonstrated a median deviation of 1.5 mm (range 0.0–20.0 mm), with the anteroposterior position showing the least variability. RadTat durability analysis showed a median time to first replacement of 11 calendar days (95% CI: 5–15). The 7-day replacement free probability was 75% (95% CI: 42.8%– 94.5%), and at 14 days, this probability fell to 33.3% (95% CI: 9.9%–65.1%). Across the treatment course, individual RadTats required a median of 3 (range 2-9) replacements per marker (mean 4.1; SD = 2.1). RadTats were substantially more expensive than permanent tattoos, with a mean per‑patient cost approximately 10.5 times higher. The majority of patients (91.7%) scored the RadTat workflow and visibility as not bothersome, indicating patient acceptability.
These findings indicate that RadTats offer acceptable accuracy and patient experience, but have limited durability for longer treatment courses and introduce additional workflow time and cost. RadTats may be a feasible option for patients who decline permanent tattoos for cultural, spiritual or personal reasons. Larger multi‑centre studies are needed to refine application protocols and determine generalisability.