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Discuss best practices and workflow advice for Surface Guided Radiation Therapy on all treatment sites.
By Pauline Ireland flag
Hi All
We are currently trialling going tattoo less with our breast patients.
Do you think having an anterior temporary mark which is a measured distance from SSN is needed so that when the lasers are on it, it intersects the breastboard scale at a recorded measurement , to aid sup/ inf position ?
Also when at CT do you still place on fiducials to mark Zero slice ?
Any tips greatly appreciated :D
By sheri_thompson
When we first went tattoo less on our breast patients we used fiducial marks for a 3 pt set up. We didn't do it very long so the therapist would use Align RT instead of marks on pt. Just so you know we are completely tattoos less on all cases. It took us a little over a year to make this happen. Good Luck :)
By muenster
In the beginning we used markings as a temporary solution to better evaluate if sgrt performs truly better than our old lbs. In hindsight i think we could have gone completely without those, as sgrt is a far superior and precise method. i can only recommend using sgrt for as many sites/indications as possible, to improve the training of colleagues and familiarity with the system. Took us around a year from the first patients with sgrt to go completely markerless.
By karen_mcgoldrick Australia flag
We use a fiducial at CT to mark the zero slice and record the couch long value at CT which is transferred to the record & verify system to ensure the patient is correct in longitudinal on couch to start.
By marko_laaksomaa Finland flag
Hi all
Some questions concerning initially correct couch LNG value. We are starting tattooless in certaint patient group in breast.
All the linacs are not yet equipped with SGRT, so this happens slowly. However, our policy in this breast group is to check the value on the side of the breast board at the CT at the mamilla level for reference level, some of you use SSN for this. This value of the fixation is marked down at the CT. Our breast boards are indexed identically at the linacs (H2), meaning that certain side value on the breast boards in the reference level indicates reliable couch LNG value at the linac. Typically, additional (1-8 cm) planned LNG shift is done during the dose planning process and this LNG shift from reference level to isocenter level is added to achieve initially adequate couch LNG value. During the first fraction this workflow guides the actual couch LNG value with TrueBeam automatic drive inside 1-2 cm from the correct one, based on AlignRT. On the first fraction, the couch values (VRT, LNG, LAT) are saved after image guidance. Is there some other way that hospitals are using to record couch LNG values at the CT for the first fraction setup than using scale of the breast board for this? How is this done in the pelvis cases for example, if there is no fixation with side values under pelvic region? I know several hospitals are doing manual couch shifts at the first fraction with moving the patient to near correct isocenter and use AlignRT for the finetuning at the time it begins to see where the patient should locate, but I think it would be great if we could use automation for this from the start for pretty much all the patients. Is someone having scale at CT couch or is this fiducial at the reference level at the CT slices used somehow to this...? Thank you, I would appreciate your answer.
Best regards Marko
By zoe_nilsson
Hi there,

I'm going to jump on board this conversation - hope that's okay. I want to start using SGRT in our department in NZ. We don't currently have the software for it and I'm wondering where to even begin to start training for myself to then implement into the department. Is attending the European meeting a good place to start or is there better ways of approaching it.

Thank you