A method and apparatus for positioning a patient for radiation treatment are described. The method includes obtaining a plurality of projection images of a patient positioned on a treatment couch, displaying at least one of the plurality of projection images with a corresponding synthetic projection image on a display, adjusting the position of the at least one projection image on the display to approximately align with the corresponding synthetic projection image in response to a user dragging the at least one projection image on the display with a user interface device, and moving the treatment couch to position the patient based on position adjustments of the at least one projection image.