Tattoo-less Radiation Treatment Adopted By Northwestern Medicine In Lake Forest, Grayslake

LAKE FOREST, IL — Patients receiving radiation treatment at Lake Forest Hospital no longer get tattoos to mark treatment areas, thanks to the installation of new technology that also reduces setup time and ensures the treatment remains on target.

In the past, radiation treatment required three tattoos to accurate triangulate a cancerous area. And for many patients, the trio of freckle-sized dots is unwelcome.

"They are visible to the naked eye," said Dr. Marc Posner, medical director of radiation oncology at Northwestern Medicine Lake Forest Hospital since 2013.

"What we've found over time is, if the dots are in an area that is not particularly visible, so lets say around the pelvis, most people you wouldn't necessarily see it, because you're wearing clothing or a bathing suit or something, and they're kind of hidden," Posner told Patch.

But breast cancer patients generally receive one tattoo between the breasts, in the center of the chest on the sternum and one on each side below the armpit, Posner said. Depending on attire, all three might be visible.

"Looking in the mirror and always seeing that dot there serves as a permanent reminder that that patient went through cancer treatments," he said. "And for some patients, that's bothersome."

A survey of women attending an organization for young breast cancer survivors published in The Breast Journal in 2019 found that only about 7 percent of women felt positively about receiving tattoos or other marks during treatment and 78 percent said they would choose treatment that avoided them.

"Up until this new technology came along, there was no alternative," Posner said. "We needed to have these marks in place so that we could make sure that we reproducibly and accurately set the patient up to exactly the same position every single day."

Within the last decade, new equipment called surface guided radiation therapy, or SGRT, has became available to cancer treatment providers, Posner said, and it does a better job without requiring permanent marks.

"It's not cheap," he said. "So it took me a bit of time to convince the hospital to invest in a system that didn't have any kind of a return on investment. There's no way to bill for this, so there was no ROI."

Posner said he argued it was worth spending on the new system to improve quality of care and the experience of patients undergoing treatment.

"It took a little bit but I was able to finally get my point across to the hospital that it was worthwhile to invest in the system, just so that we can have a better patient experience," said Posner, a Vernon Hills resident who has worked at Lake Forest Hospital since 2000.

SGRT technology takes a 3D rendering of the surface of a patient's body during a mapping session. Once in the treatment room, six cameras in the ceiling monitor a grid of lasers projected onto the patient.

"So instead of using three points with three lasers, imagine a grid of, say, 200 to 250 points all over the three-dimensional surface of the patient," Posner said.

The three pairs of cameras can then construct the surface of the patient in a kind of 3D virtual space to make sure their whole body is lined up properly, not just the three tattooed points.

"So we're utilizing substantially more points of reference to set the patient up, but it turns out, the way the system works, the setup is faster. We're getting a more accurate setup in less time," he said.

And the new technology comes with a secondary benefit — if a patient coughs or shifts or otherwise moves on the treatment table outside of preprogrammed parameters, the cameras are keeping track and the treatment can be halted.

Posner said it turned out that a number of patients were very afraid of moving while undergoing treatment under the previous system.

"That's actually a point of anxiety that we didn't really recognize fully ahead of time, because we had no options, we had no technological alternatives to using the three-point setup. Now that we have this system, I can reassure patients who are nervous about moving that it doesn't matter if they move," Posner said.

"So they don't have to have that anxiety added on to the normal stressors of going through radiation," he added. "We're able to actually make this less anxiety-provoking for them by using this technology."

SGRT is at least as accurate as tattoos and has shown to be 21 percent faster, according to Northwestern Medicine representatives.

Patient Debra Kaden was diagnosed with an aggressive form of breast cancer and told she would need both chemotherapy and radiation.

“Receiving a cancer diagnosis and going through treatment is challenging,” said Kadin, of Northbrook. “I’m relieved that I didn’t have to carry a permanent reminder of my treatments like patients had to before this technology was available.”

The radiation oncology department at Lake Forest Hospital has now been fully tattoo-less for just over three years, its director said. Tattoo-less radiation treatment is also available at Northwestern Medicine's Grayslake outpatient facility.

"We actually use it on literally every patient that we treat now. We have completely gotten rid of the tattoo equipment in this department, and the system is faster and more accurate at setting patients up," Posner said.

"All of our patients here benefit from this technology without even knowing that they're benefiting from it," he said. "From the patient-forward perspective, the only thing that they do know is that they don't have to get poked with needles."