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

## TL;DR

This study shows that marker-less patient setup in breast radiotherapy is preferred by patients and staff, and it provides similar accuracy with shorter treatment times.

## Contribution

The study demonstrates the feasibility and benefits of marker-less breast radiotherapy setups using a 6D couch, showing reduced treatment time and high user preference.

## Key findings

- 90% of patients and radiation therapists preferred marker-less setups over traditional methods.
- Marker-less setups with a 6D couch achieved comparable positioning accuracy to marker-based methods.
- Marker-less setups reduced total treatment time by 27.8% without affecting setup or IGRT times.

## Abstract

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.

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.

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%.

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.