External beam radiation treatment is usually carried out in fractions over a few weeks. Each treatment fraction uses the same technical parameters and radiation dose. Most importantly treatment position for an individual must be the same for every treatment session.

The treatment position for each individual is determined during simulation procedure. The same position can be reproduced in the treatment room by following the written instructions, using the identical treatment accessories and drawings on the skin surface.

What Are Skin Drawings?                                                                                                                                                                                                          

After the decision on the treatment position is made, some drawings will be put on the skin surface. These markings are drawn in relation to a person’s bony structures and anatomical features. The marks have to be reproduced easily.

Some skin drawings (picture A) are used as reference marks to position the person on the treatment couch. Some markings (picture B) are used to show the treatment areas.

How Are The Skin Drawings Produced?

Skin drawings can be produced using felt marker pens OR ink drops.

Drawings Using Marker Pens

This is a simple procedure and marks are drawn on the skin surface using marker pens. These marks are not lasting because they can become faded when the person sweats, take a bath or the marks are transfered to the clothings. Then the marks have to be redrawn everytime they become less visible.

Marks on curved body surface are difficult to reproduce. The person may be adviced not to wash the treatment area everyday in order to avoid losing such marks.

Markings Using Ink Drops

This procedure uses a sterile needle or an ink dispenser (Steritatt CIVCOR) to deposit tiny drops of non-toxic ink under the top layer of skin. The needle pricks may hurt a little like mosquito bites.

A. Marking using sterile needle	B. An ink dispenser	C. An ink dot

About 5 to 7 ink dots measuring 1 – 2mm will be placed at identified spots on the body. These marks are cleaner and does not stain clothings compare to those using marker pen. The ink dots can last longer and may be permanent. This method will allow a person to wash the treatment area everyday without worrying about losing the ink marks.

However, do let the radiation therapist know if you have very sensitive skin or skin allergy so that they can apply other method of marking.

Is The Ink Drop Method Safe?

The method of putting ink drops under the skin surface is a safe procedure that is carried out using the clean procedure technique.This marking procedure and the material used was presented to the Fatwa Committee of the National Council for Islamic Religious Affairs Malaysia. The council has approved the procedure to be carried out for muslims. For details information of this ruling, please refer to http://www.e-fatwa.gov.my/fatwa-kebangsaan/hukum-penggunaan-penandaan-berdakwat-pesakit-kanser.

References

1. Rathod S., Munshi A. & Agarwal J. Skin marking methods and guidelines:A reality in image guidance radiotherapy era. South Asian J Cancer. 2012 Jul-Sep; 1(1): 27–29. doi: 10.4103/2278-330X.96502
2. www.e-fatwa.gov.my
3. Image from Skin marking methods and guidelines:A reality in image guidance radiotherapy era. South Asian J Cancer. 2012 Jul-Sep; 1(1): 27–29.
4. Images from silde presentation to the National Council for Islamic Religous Affairs Malaysia
5. Images form slide presentation of Rubiah M P. Medical use of x-ray in Radiotherapy.