Half a year after the introduction of AlignRT we have gone markless and tattoo less as well. I fully agree with the good arguments of Jacqui. Skin marks will never be a good and satisfying landmark for precise positioning. We used them, because we had no alternative. Now we have one! AlignRT, as the skin marks, serves as a “first guess”. For precise, final positioning we still use daily kV-kV imaging and correct position based on anatomical matching. First data show that the “first guess” by AlignRT is in most of the cases already a good one! In our institute we have two dosimetrical identical machines and both are equipped with AlignRT. So in case of a technical issue with AlignRT we still can continue to treat patients on the other machine. I guess with the introduction of new smart technology in our clinics we should also consider to give up some old “technology” like skin marks to the benefit of both, patients and RTTs!