1. MVCBCT at UCSF A Team Creation by Michèle Aubin IGRT Specialist Prostate Alignment

2. Prostate Patient Here is a typical Coherence screen after the 3D image acquisition and the automatic registration are done for a prostate patient.

3. - Click the ‘Fusion Bending’ tool, and the Blending Dialog will appear.

4. - In the Blending Dialog window, slide to the left the blending tool (Cone Beam (CB) Image), - Select Invert Grayscale in the Lookup Table and, adjust the Window-Values tool. - In the Blending Dialog window, slide to the left the blending tool (Cone Beam (CB) Image), - Select Invert Grayscale in the Lookup Table and, adjust the Window-Values tool.

5. - In the Blending Dialog window, slide to the right the blending tool (CT Reference Image), - Select Grayscale in the Lookup Table and, adjust the Window- Values tool. - In the Blending Dialog window, slide to the right the blending tool (CT Reference Image), - Select Grayscale in the Lookup Table and, adjust the Window- Values tool.

6. -Adjust the image with the Zoom tool.

7. - In the Blending Dialog window, slide to the left the blending tool, - On the coronal CB view (bottom), localize the three gold markers (GM) by scrolling images (Apex in this case). - In the Blending Dialog window, slide to the left the blending tool, - On the coronal CB view (bottom), localize the three gold markers (GM) by scrolling images (Apex in this case).

8. (Right Base in this case)

9. (Left Base in this case)

10. - In the coronal view, bring the red horizontal line over the left base GM. This will bring the GM in the transversal view (upper left).

11. - In the coronal view, bring the green vertical line over the right base GM. This will bring the GM in the sagital view (upper right).

12. - In the coronal view, localize the apex GM. Now you have three different GM in each view; the left base in the transversal view (upper left), the right base in the sagital view (upper right) and the apex in the coronal view (bottom). - In the coronal view, localize the apex GM. Now you have three different GM in each view; the left base in the transversal view (upper left), the right base in the sagital view (upper right) and the apex in the coronal view (bottom).

13. - Slide the blending tool to 1/3. The CT and the CB appear together overlapping each other.

14. - Click on the Manual Registration tool and move the CT over the CB. Suggestion: Move the most obvious white CT-GM (in this case the right base) over the black CB-GM.

15. - Adjust one of the two other GM.

17. - Click the Accept button.

18. - On the left are the initial table coordinates. -On the middle are the new table coordinates (absolute). -On the right are the relative table moves. - On the left are the initial table coordinates. -On the middle are the new table coordinates (absolute). -On the right are the relative table moves.