Comparison of three methods for skin markings in conformal radiotherapy, temporary markers, and permanent Steritatt CIVCO® tattooing: Patients’ comfort and radiographers’ satisfaction

Skin marking is routinely performed at the time of simulation before radiotherapy treatment. Worldwide different methods are used to mark the isocenter; most commonly used are temporary marker pens, commercially available tattooing needles pre-filled with non toxic India ink (Steritatt CIVCO®) and henna. The aim of this study was to compare these three different methods in the terms of durability, repetition of marking session, any allergic reactions, patient comfort and radiographer satisfaction. Sixty patients with early prostate cancer were selected who were due to undergo radiation for eight to nine weeks duration. At the time of simulation, the participants’ skins were marked by one of the three methods: temporary marker pens, henna, and Steritatt CIVCO® needling. The patients were evaluated for the durability of markings, number of times the markings were repeated and allergic reactions. The patients’ comfort was assessed by using a scoring system: they were asked to assess the method of the marking used. A rating scale was used: 1 = happy with marking method, 2 = seeking an alternate option. The radiographers were asked to score one of the methods using a scale 1-3: 1 = better, 2 = comparable, 3 = worse. Mean duration of the skin markings was four days (2-5), 18 days (10-27) and 40 days for temporary marker pens, henna, and Steritatt CIVCO® needling, respectively. Patients with henna and permanent markings were equally satisfied with the less number of repeated markings. However radiographers were unsatisfied with henna because of the prolonged drying period (mean = 15 minutes). No skin allergies were seen in any procedure. Permanent markings remain the standard for a radiotherapy unit, patients and radiographers. Although patients were happy with the henna markings it is not recommended due to prolonged drying period and the need for repeated skin markings.