When it comes to radiation therapy set-up marks, one question continues to come up across departments: Should we be using permanent tattoos or temporary marks? The answer has always been: it depends. But today, that answer is evolving.
Radiation therapists are being asked to balance more than just accuracy. Workflow efficiency, patient comfort, and long-term experience all play a role. And increasingly, teams are looking for options that don’t force a trade-off between them.
The Reality of Permanent Marks
Permanent tattoos have long been the standard, and for good reason. They provide consistency throughout treatment and eliminate concerns about fading or re-simulation.
They also create a lasting clinical reference point, which can be valuable in cases of recurrence. But in practice, they’re not without challenges.
Small tattoo marks can be difficult to locate, sometimes adding minutes to each setup, especially for patients with darker skin tones, freckles, or body hair. Over time, factors like aging or weight changes can also affect their accuracy.
And perhaps most importantly, not every patient wants a permanent reminder of their cancer experience. Cultural beliefs, cosmetic concerns, and personal preference all come into play.
Visibility Issues and Patient Acceptance Temporary Marks: Flexible, But Not Without Friction
There are times where the tattoo is not easily visible, as noted above. The marks are very small and sometimes it can take up to 5-7 minutes for the radiation therapist to locate them all prior to each treatment session.
In these instances radiation therapists must either take extra time to find the small bluish-black set-up marks or use other methods to quickly identify them at each treatment. Some of these methods include drawing lines or circles around the mark with a temporary marker - which in itself can have its own drawbacks if proper precautions are not taken to ensure their longevity; investing in black light responsive inks; or using an external cover over the mark, such as Beekley's PointGuards®, to quickly draw attention to it.
There is also the issue of patient acceptance - some patients object to permanent tattoos. Considerations include cultural or religious beliefs, cosmetic concerns (particularly on face and neck areas), and patient attitudes towards having a permanent reminder of their cancer experience.
The value of knowing the exact site of treatment is lost to clinicians when patients opt to have their tattoos removed or, as is trending among breast cancer patients, turned into decorative tattoos along with their surgical scars.
Age and weight gain/loss also compromise the accuracy of the tattooed record of the treatment site over time as the marks are motile with changes in skin elasticity and no longer consistent with internal structures. And, of course, "stick" injuries to both patient and staff always need to be considered when needles are involved.
Temporary Marks: Flexible, But Not Without Friction
Temporary marks, like a Sharpie mark, offer a clear advantage: they’re not permanent.
For many patients, that alone improves the overall experience. There’s no long-term visibility, no lasting reminder, and more control over their body after treatment.
But from a clinical standpoint, temporary marks can introduce workflow challenges.
They can fade, wash off, or require reapplication, sometimes leading to re-simulation. To extend their life, marks are often covered with dressings, which can be time-consuming to apply and uncomfortable for patients, especially as skin becomes more sensitive during treatment.
Rethinking Temporary: A More Durable Approach
This is where many departments are starting to rethink what “temporary” really means. Instead of choosing between permanence and inconsistency, newer solutions are emerging that offer both durability and flexibility.
InkRight® semi-permanent skin markers were designed with this balance in mind.
- Marks last up to two weeks, reducing the need for frequent reapplication
- Water-resistant design allows patients to maintain normal hygiene routines
- No needles required, eliminating stick risk and improving patient acceptance
- Less reliance on dressings, reducing skin irritation and setup time
In practice, this means fewer interruptions to workflow and a more comfortable experience for patients.
A Better Experience for Patients and Staff
What’s becoming clear is that this isn’t just a clinical decision anymore, it’s an experience decision.
Radiation therapists are looking for ways to:
- Spend less time re-establishing marks
- Reduce variability in daily setup
- Minimize skin irritation and patient complaints
- Offer options that respect patient preferences
Semi-permanent solutions like InkRight® help bridge that gap, supporting consistency without committing patients to permanence.
Finding the Right Fit for Your Department
There’s still no one-size-fits-all answer. Permanent marks, traditional temporary methods, and newer semi-permanent options all have a place depending on patient needs and departmental workflows.
But as expectations shift, many teams are re-evaluating what “best practice” looks like.
Because in the end, it’s not just about marking the treatment site, it’s about delivering care that works better for everyone involved.
Looking for a more flexible approach to set-up marking?
See how InkRight® can help improve both workflow efficiency and patient experience in your department by requesting a complimentary sample.
