Patient and staff perspective toward marker‐less patient setup accuracy in breast radiotherapy

PURPOSE: This study comprised two cohorts. The first assessed patient and radiation therapist (RTT) perspectives on temporary ink skin markings. The second evaluated whether integrating a six-degree-of-freedom (6D) couch could further improve setup accuracy, setup time, IGRT time, and total treatment time when used with marker-less or marker-based workflows. METHODS: Questionnaires were completed by 72 breast cancer patients and 29 radiation therapists (RTTs) using a 6-point Likert scale (0 = never to 5 = always). The questionnaire assessed emotional experiences related to temporary skin markings and the level of interest in a marker-less approach. Forty patients were assigned to four setup groups: markers without 6D couch (M), markers with 6D couch (M_6D), marker-less without 6D couch (ML), and marker-less with 6D couch (ML_6D). Setup accuracy, setup time, image-guided radiotherapy (IGRT) time, and total treatment time were compared. RESULTS: About 90% of both patients and RTTs preferred a marker-less setup. Marker-less techniques combined with 6D couch achieved comparable positioning accuracy to marker-based methods. Maximum mean setup deviations in the longitudinal axis were 3.3 ± 1.3 mm (M), 3.3 ± 1.5 mm (M_6D), 2.8 ± 1.3 mm (ML), and 3.0 ± 1.5 mm (ML_6D). No significant differences were found in setup or IGRT time. Marker-less setups reduced total treatment time by 27.8%. CONCLUSION: Marker-less setups using SGRT are feasible for breast radiotherapy, providing comparable accuracy and reduced treatment times. Both patients and RTTs preferred this method over traditional marker-based approaches.