Although adverse reactions to ICG are known to occur, this dye has been used safely for more than 50 years in tests of cardiac and hepatic function, and more recently for sentinel node detection in cancer surgery. Indocyanine green (ICG) has been described in some reports of animal models as an alternative candidate to India ink. However, India ink is currently not available in Korea because it has not yet been approved by the Ministry of Food and Drug Safety in Korea. India ink tattoos properly placed in the colorectum are long-lasting and are reported to remain constant therefore, they are being commonly used for colonic tattooing. Įndoscopic tattooing of colonic lesions to assist in operative localization was first described in 1975. Each of these methods has drawbacks including, respectively, inaccurate localization, use of radiation, migration and poor cost performance of clips, and colonic insufflations. For that reason, several methods, including barium enema, preoperative colonoscopy combined with fluoroscopy, placement of mucosal clips, and intraoperative colonoscopy, have been used to localize colorectal tumors during laparoscopic surgery. The lack of accurate lesion identification during laparoscopy may lead to resection of the wrong segment of the bowel. Therefore, accurate localization of colorectal tumors remains of critical importance during laparoscopic surgery. Intraoperative identification of lesions previously detected by endoscopy is often particularly difficult during laparoscopic surgery because of the inability of surgeons to palpate the colorectum intraoperatively. Minimally invasive laparoscopic surgery for patients with colorectal cancer has become a popular alternative to conventional surgery due to its having comparable survival and recurrence rates. - Copyright transfer agreement and conflict of interest disclosure.- Instructions for uploading manuscripts.Therefore treatment of superficial lesions with electron beams in a tattooed area should be monitored for signs of early skin reaction during radiation therapy treatments. Based on this initial study, we conclude that commercially available tattoo inks contain large amounts of high-Z metals that may contribute to dose perturbation. The dose perturbation ranged from 1.4% up to 6% for the yellow ink for the 6 MeV electron beam, with similar values across the rest of the electron energies, whereas the black, red, and blue inks presented up to 3% dose perturbation for the same range of energies. The elemental concentration in the tattoo ink samples showed high-Z elements, with Z ranging from 11 to 92. An ultrathin-window parallel plate ion chamber was used to measure the surface dose perturbation (ratio of ionizations with and without tattoo ink) for 6 - 20 MeV electron beams. The elemental composition of the tattoo ink samples was analyzed using X-ray Fluorescence (XRF). Four commercially available tattoo ink colors, black, red, yellow, and blue were chosen. This study investigates the dosimetric effects in surface dose due to high-Z elements in tattoo ink under electron beam irradiation. However, tattoo ink ingredients include heavy metals (high atomic number Z) that are not regulated, which can cause skin reactions. It is estimated that approximately 24% of the US population has at least one tattoo.
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