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To investigate potential dosimetric improvements through the optimization of fixed‐couch rotational position in cranial cancer stereotactic treatments.

Using previously delivered cranial stereotactic radiotherapy plans treated at the Nova Scotia Health Authority (NSHA), we have redesigned the treatment arrangement to find the optimal couch rotation positions based on the reduction of overlap between organs‐at‐risk of exposure (OARs) and target volume (PTV). Maintaining the gantry arrangements from the delivered treatment, the couch positions were determined based on a cost function analysis of accumulation of overlap score from an equation developed by Yang et al. and refined by MacDonald et al. The algorithm incorporates factors for radiation dose sensitivities of each OAR, depth of both OARs and target (PTV) volumes, and orthogonality of the 3D vector between OAR and PTV in the …