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For postmastectomy radiation therapy by proton beams, the usual bony landmark based radiograph setup technique is indirect because the target volumes are generally superficial and far away from major bony structures. The surface imaging setup technique of matching chest wall surface directly to treatment planning computed tomography was evaluated and compared to the traditional radiograph-based technique.

Fifteen postmastectomy radiation therapy patients were included, with the first 5 patients positioned by standard radiograph-based technique; radiopaque makers, however, were added on the patient's skin surface to improve the relevance of the setup. AlignRT was used to capture patient surface images at different time points along the process, with the calculated position corrections recorded but not applied. For the remaining 10 patients, the orthogonal x …