What is the best method for ensuring that vaginal cuff cylinder is in proper position at each fraction?

The best method depends on local context and what tech is available.

For imaging, one can: re-CT each treatment, use fluoro (we have a C-arm), use the kV or MV imager on a Linac with an orthogonal pair or a CBCT. There are other methods also. Some practices don’t image verify (makes me nervous).

For...

We do not have fluoroscopy available in our clinic. I insert the cylinder in CT sim, secure it using a stabilizer board, and obtain AP and lateral scout films to compare to the prior imaging. We then move the patient by stretcher to the HDR unit. Our therapists put reference marks on the patient to ...

I do a CT scan with stabilizing arm in place (as necessary based on patient anatomy) every fraction. Insertion is done on the CT simulation cylinder table, usually in frog-leg position.

The treatment is planned after 1st scan. Subsequent scans are only to confirm positioning looks the same as the fi...