Innovation to improve patient experience: mask painting in paediatric radiotherapy

Whilst there has been considerable advancement in clinical oncology, whether technical, such as increasingly precise target delineation, or biological, including the emerging field of radiogenomics, the experience of radiotherapy remains distressing for many patients. Such anxiety may be exacerbated by the use of radiotherapy masks, required to immobilise patients in whom the target is located in the brain, head or neck, particularly so in the paediatric population. It is thus critical that the tolerability of our treatments be optimised, and often this is underpinned by creativity and innovation.

Indeed, a novel means of allaying fear in children due to undergo radiotherapy is painting the radiotherapy masks as their favourite character or animal. Although the idea is believed to have originated in the North America, with several local media reports in 2012, it only gained media attention in the UK in October 2017. (1) Lobke Marsden, a radiotherapy play specialist based at Leeds Children’s Hospital, posted a picture on her Twitter page of a mask she had painted as Darth Maul from the Star Wars franchise which subsequently went viral. (2) Marsden highlighted that the plain white masks can often be intimidating for young people, and having it painted as their favourite superhero, for example, can allow them to assume that persona, almost re-conceptualising the experience for the child, affording greater

co-operativity, confidence and sense of autonomy in their treatment. In addition, she utilises a model linear accelerator to simulate radiotherapy with a toy doll to familiarise children with the procedure. Indeed, by assuaging the child’s fears, they found a decreased need for general anaesthesia during treatment. This was also reported in a similar project at Addenbrooke’s Hospital in Cambridge, in which older children could choose to paint their own masks as part of their initial treatment work-up. (3)

Following these positive outcomes, the practice has quickly disseminated, and inspired the minds of children and healthcare professionals alike, at cancer centres across the UK, with esteemed childhood greats including Spiderman, Captain America, Elsa, and Pikachu all having their likeness emulated in mask form. Indeed, in December 2017, it was announced that funding had been allocated for masks to be designed for paediatric patients at the Beatson West of Scotland Cancer Centre in Glasgow. (4) One of the initial participants, Molly, aged 12, stated that despite radiotherapy being painless, the linear accelerator “was huge, and being strapped down and told to stay completely still was scary,” adding that the individualised designs made the experience more personal, and less clinical. Indeed, it is imperative that such innovation, and the sharing of best practice between cancer centres, be allowed to flourish, in order to continually improve the tolerability of all aspects of cancer diagnosis and management, which is invariably a harrowing experience for the patient and their families.

View Lobke Marsden’s radiotherapy masks on her Twitter page:

BBC Look Yorkshire Video Report on Radiotherapy Mask Painting:


Ryan Mulholland Clinical Oncology Ambassador References

  1. LHSC. Easing radiation anxiety for children. LHSC Radiation Therapist puts artistic skills to good use. 2012 [cited 29/01/2018]. Available from:

  1. Leeds Children’s Hospital. Radiotherapy team transform masks for young patients. 2017 [cited 28/01/2018]. Available from: for-young-patients

  1. Leng, F. How a unique project at Addenbrooke's is helping young radiotherapy patients. 2017 [cited 28/01/2018] Available from: https://www.cambridge-

  1. Beatson Cancer Charity. Glasgow clinical technologists transform radiotherapy masks for children. 2017 [cited 28/01/2018]. Available from:

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