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Discuss best practices and workflow advice for Surface Guided Radiation Therapy on all treatment sites.
By ben_allen
#181
Hi all.  I am in the process of moving our department to markerless for breast radiotherapy.  How many people out there are completely mark and tattoo free? what were you biggest lessons in going through the process?



Thanks,
By ellen_herron_bsrtt
#183
We are completely markless and love it! Have a game plan and think through possible problems ahead of time. We me with head of physics, dosimetry and our director to brainstorm how we would handle certain situations if they did arise (ex. system going down). We also went through a 3 month "trial run" where we agreed to keep marks as a back up. The trial was a success and we haven't looked back since :) *Tip: We make sure we index all of our patients and use tighter tolerance tables, even if we have to get creative. In addition to Vision RT we also can be confident we are in our correct position by in tolerance table parameters, checking medial light field and verifying medial SSD daily*
By suzanne_coupland
#184
We are also looking into going markerless, but have heard from other centres that they do still use measurements and pen marks, at least to get to a starting point. Our particular concern is regarding breasts, who are mostly treated on an incline, and although the breastboard is fixed, and the bumstop positioned, we still have to ask the patient to move up or down to get them at the correct point on the board. We have discussed measuring a point halfway between the ssn and xiphi to give us a starting point, but does anyone have any other solutions?

Do centres use pitch as the biggest indicator for patient positioning on the incline?

Any advice would be greatly appreciated, thanks
By suzanne_coupland
#188
On the same thread, what contingency plans do other centres have in place if Align were to fail for any extended period, with markerless treatments?

By marko_laaksomaa Finland flag
#190
Hi

One fresh article to this topic:

Eliminating Daily Shifts, Tattoos, and Skin Marks: Streamlining Isocenter Localization With Treatment Plan Embedded Couch Values for External Beam Radiation Therapy, Practical Radiation Oncology, Volume 9, Issue 1, January–February 2019, Pages e110-e117, Sueyoshi et. al.

Marko
By ellen_herron_bsrtt
#193
We sometimes do have pitch issues and have to make adjustments but they correlate with what VisionRT is telling us. So, Do you use a vacloc for the arms on top of the breastboard?

In our clinic if the system were down, we would use our table parameters along with imaging and ssd checks for patient positioning. If we thought it might be down the next day then we would place marks and use them until the system came back up.
By deirdre
#199
Hi,

We have a rendered imaged uploaded and do a quick check of the border posistion on lateral and medial
By suzanne_coupland
#204
We no longer check field borders as we have no reference mark to check with, however we have found that a combination of AlignRT and on treatment imaging confirms patient positioning. We do still check breast coverage with the light field before exiting in the room, including in breathold for our DIBH patients
By ling_zhuang
#205
Hi Marko, could you possibliy share the article with me? I do not have access to full article. very interested. thank you!