For example, in radiation treatment of cancers, the level of oxygen in the tumor is the single most important variable that affects the treatment outcomes. Diseases whose treatment strategies would benefit from taking tissue oxygen into account include tumors, peripheral vascular disease, and wound healing. If measured at all, oxygen level is assessed in the vascular system, while the greater need for many clinical applications is to know the oxygen level in tissues. Despite this importance, oxygen in tissues is seldom measured directly. The clinical value of repeated measurements of oxygen in tissues rests fundamentally on the central roles that oxygen levels play in a large array of physiological and pathophysiological processes. While India ink has a long history of safe use in tattoos, a systematic research search regarding its safety for marking tissues for medical uses and an examination of the evidence that differentiates between ink based on charcoal or carbon black has not been conducted. The most immediately available oxygen sensor is India ink, where two classes of carbon (carbon black and charcoal) have been identified as having acceptable paramagnetic properties for oximetry. EPR oximetry has many potential advantages over other ways to measure oxygen in tissues, including directly measuring oxygen in tissues and being particularly sensitive to low oxygen, repeatable, and non-invasive after an initial injection of the EPR-sensing material is placed in the tumor. Oximetry can provide important information useful for prognosis and to improve patient outcomes. Clinical EPR spectroscopy is emerging as an important modality, with the potential to be used in standard clinical practice to determine the extent of hypoxia in tissues and whether hypoxic tissues respond to breathing enriched oxygen during therapy.
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