E1930. A Sweeter Solution to Skin Marking
  1. Chase Glenn; Wake Forest School of Medicine
  2. Herbert Caudill; Wake Forest School of Medicine
  3. T. Santoro; Wake Forest School of Medicine
  4. Kevin Hiatt; Wake Forest School of Medicine
Skin markers can improve radiologist confidence and accuracy in identifying imaging correlates to palpable abnormalities. Unfortunately, metallic skin markers used for CT studies result in beam hardening artifact and may obscure the lesion of interest, particularly if it is small and superficial. This limitation of metallic markers may discourage technologists from using them, even in cases where skin markers would be valuable to the interpreting radiologist. Individually-wrapped candies are a low-cost alternative to metallic markers that are easily visualized on standard imaging windows, are less likely to be confused with pathology, and do not result in noticeable beam hardening artifact.

Materials and Methods:
We retrospectively reviewed CT studies performed on 30 patients with a variety of skin markers, including metallic BBs, hard and gummy candies, and vitamin capsules. Individually-wrapped candies were affixed loosely to the skin using tape provided there was no open wound in the area or patient allergy to tape and then were removed after completion of the study. Specific candy types used included peppermint hard candies, Starburst© candies, Jolly Rancher© hard candies, gummy bears, and Werther’s Original caramel hard candies. Vitamin capsules were attached to the skin in the same fashion. Two radiologists reviewed each case. They assessed the ease of visualizing and identifying the skin marker used and commented on any associated artifacts.

Metallic BBs were easily visualized, but were sometimes confused for foreign bodies or support apparatus and invariably had beam hardening artifact with partial obscuring of adjacent tissues. Vitamin capsules were easily visualized and did not have noticeable beam hardening artifact, but due to density were sometimes confused as exophytic skin lesions. All candy types used were easily visualized and recognizable, particularly the peppermint candies due to radiating internal architecture and gummy bears due to their unique morphology. No noticeable beam hardening artifact was noted with any candy type used. Additionally, individual packaging allowed for a small air gap between the candy and underlying skin, facilitating assessment for skin lesions.

We propose individually-wrapped candy as an effective alternative to metallic skin markers in the CT assessment of palpable abnormalities. Not only do individually-wrapped candies result in less beam hardening artifact compared to metallic markers, but they are easily recognizable and facilitate assessment for skin lesions by allowing for an air gap between the marker and underlying skin.