After a CT simulation for a patient treated prone on a breast board, the record shows documented skin marks and four saved setup photographs, but the written setup note says only 'prone with the board in use.' Which update to the simulation documentation is needed before the plan is reviewed?

The setup note must let the treatment team reproduce the simulation position from the written record. The correct update documents all four required elements: board angle, table orientation, arm and head placement, and mark locations. Saved photographs and skin marks are useful supporting references, but they do not replace these details in the setup note. Relying on an indexed board angle is insufficient because the note would not state the angle actually used; indexing alone may not identify the simulation setting or ensure it is selected again. Likewise, assuming a standard table orientation leaves the actual simulation orientation undocumented, which matters if the room, equipment, or workflow differs from the assumed standard. Saved images can help locate marks, but they do not satisfy the requirement to record mark locations in the note, and may be less convenient to consult during daily setup. Exam caveat: a local template or indexed setup can support reproducibility, but it does not override a requirement to document the actual simulation configuration. Practical check: compare the completed note with the simulation record and confirm each required item is explicitly recorded before plan review.