Eliminating Daily Shifts, Tattoos, and Skin Marks: Streamlining Isocenter Localization With Treatment Plan Embedded Couch Values for External Beam Radiation.

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Eliminating Daily Shifts, Tattoos, and Skin Marks: Streamlining Isocenter Localization With Treatment Plan Embedded Couch Values for External Beam Radiation Therapy Mark Sueyoshi, MD, Arthur J. Olch, PhD, Kevin X. Liu, MD, DPhil, Alisha Chlebik, BS, RTT, Desirae Clark, BSN, RN, Kenneth K. Wong, MD Practical Radiation Oncology Volume 9, Issue 1, Pages e110-e117 (January 2019) DOI: 10.1016/j.prro.2018.08.011 Copyright © 2018 American Society for Radiation Oncology Terms and Conditions

Figure 1 (Top) QFix Portrait S-frame at user origin (68.8 cm). (Bottom) QFix kVue DoseMax at H2 user origin (112 cm). Practical Radiation Oncology 2019 9, e110-e117DOI: (10.1016/j.prro.2018.08.011) Copyright © 2018 American Society for Radiation Oncology Terms and Conditions

Figure 2 (Top left) User origin (green cross) shown for VMAT CSI plan (brain isocenter depicted only), defined as zero in lateral, vertical, and longitudinal coordinates (Table 1). (Bottom left) Dashed intersection indicates plan isocenter. Delta couch shifts from user origin to isocenter are used to determine absolute couch parameters (Table 1). (Right) Shift-sheet report showing a graphical representation of the motions of the couch from the user origin to isocenter for each of the 3 isocenters of the VMAT CSI plan. Abbreviations: CSI = craniospinal irradiation; VMAT = volumetric modulated arc therapy. Practical Radiation Oncology 2019 9, e110-e117DOI: (10.1016/j.prro.2018.08.011) Copyright © 2018 American Society for Radiation Oncology Terms and Conditions

Figure 3 (Top) User origin (green cross) for metatarsal sarcoma inadvertently placed at CT simulation 5 cm away from intended couch-top landmark, H3 notch. (Middle left) User origin (green cross) shown for metatarsal sarcoma VMAT plan. (Middle right) Dashed intersection indicates isocenter. Delta couch shifts from user origin to isocenter are used to determine absolute couch parameters (Table 2). (Bottom) Daily online image guided translational and rotational shifts for VMAT treatment of a metatarsal sarcoma (Table 3). Abbreviations: CT = computed tomography; VMAT = volumetric modulated arc therapy. Practical Radiation Oncology 2019 9, e110-e117DOI: (10.1016/j.prro.2018.08.011) Copyright © 2018 American Society for Radiation Oncology Terms and Conditions

Figure 4 AlignRT detecting setup error of 5 cm if user origin was inadvertently assigned H3 couch value, resulting in incorrect absolute longitudinal couch value. Practical Radiation Oncology 2019 9, e110-e117DOI: (10.1016/j.prro.2018.08.011) Copyright © 2018 American Society for Radiation Oncology Terms and Conditions