Mark-free radiation treatments with VisionRT at Miulli.ART

22 February 2021

Ospedale Generale Regionale “F. Miulli” in Acquaviva delle Fonti is the first centre in Italy to perform tattoo and mark-free radiation therapy treatment thanks to AlignRT.


VisionRT, a British landmark for SGRT procedures (Surface Guided Radiation Therapy), awarded the advances radiotherapy centre Miulli.ART (Advanced Radiation Oncology) with a Tattoo and Mark-Free Treatment Centre prize, solely earmarked for the users of AlignRT system.

The centre based in Acquaviva delle Fonti has been recognized as one of the hundred centers worldwide, and the first one in Italy, which perform mark-free radiation therapy treatments, thanks to all the makings of AlignRT.

This award gave us the chance to ask Dr. Alba Fiorentino, Head of Radiation Oncology department Miulli.ART and Dr. Ilaria Bonaparte, Chief of Medical Physics in Miulli.ART, about their experience with AlignRT and their opinion about radiotherapy tattoos.


Here’s what they told us.

Tattoos and marks have always been crucial in the clinical workflow of a radiation therapy treatment. In spite of the advent of IGRT (Image Guided Radiation Therapy), any preliminary daily positioning of the patient will need three tattoed marks on the skin.
From a patient point of view though, said marks are not properly perceived as benignant, for several different reasons; these are visible tattooes, for others and for oneself, and they’re permanent: an unwelcome, perpetual reminder of therapy, often clashing against one’s social and religious beliefs.
Moreover, from a strictly practical point of view, as few as three marks tattooed on such an elastic and unstable surface as the skin won’t make for a reliable and reproducible positioning procedure.

The Radiation Oncology of Miulli hospital can offer patients the chance to skip tattoo marks, thanks to the AlignRT system.
While positioning, AlignRT casts hundreds thousand of bright spots on the patient’s skin: some sort of virtual marks that give a significantly higher amount of data if compared to three tattoo marks only. This allows to quickly apply corrections both on the translation and the rotation plan. The resulting positioning is constantly monitored during the whole treatment session, blocking the beam at any unforeseen variation occurrence (ie patient is moving, breath flow is inconsistent…).



Our ward saw a gradual implementation of AlignRT: the first patients to have their marks spared were the ones having their treatment done on the mammary gland (both in free breathing and DIBH Deep Inspiration Breath Hold). Once past this validation stage and gained acquaintance with the system accuracy, we got rid of tattoos for pelvic treatments first, and extra-cranial stereotactic treatments later.
AlignRT has now become an essential part of our clinical routine, effectively decreasing the patient positioning time and improving accuracy at the same time, with no need for tattoos”.




What makes AlignRT unique is the use of six (6) HD stereoscopic cameras with the highest speed of analysis of images (processing frame rate), which allows to recreate a 3D model of the patient surface in real time, with a sub-millimetric accuracy in computing the patient movements within the six degrees of freedom (X, Y, Z, Yaw, Roll, Pitch), before and during the treatment.

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Posted in Radiotherapy
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