An example treatment system includes: a treatment couch for holding a patient fiducials associated with the patient an imaging system to capture an image of the fiducials and of an irradiation target while the patient is on the treatment couch, where the image is captured in a treatment room where treatment is to be performed a mechanism to move the treatment couch and a computer system programmed to align locations of the fiducials to the fiducials in the image, and to determine a location of the irradiation target relative to a treatment system based on locations of the fiducials and based on the image. The movement of the treatment couch into a treatment position in the treatment room may be based on the location of the irradiation target.
