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Aims Alignment tattoos on a lax abdomen contribute to misalignment of patients undergoing abdomino-pelvic radiotherapy (RT). The present study was undertaken to assess setup reproducibility in gynecologic cancer patients positioned identically but aligned for treatment to machine isocenter by two different ways. Materials and methods A prospective study in 35 women treated with radical RT for gynecologic malignancy was undertaken. A RT planning contrast-enhanced computed tomography scan in the supine position using an foot and ankle pos