A patient positioning system includes a patient support device and a positioning apparatus including a body comprising a front end, a first lateral side, a second lateral side, and a ramped surface between the first lateral side and the second lateral side, a tail extending from the front end of the body, the tail comprising an elongated piece of material, and a directional guide material coupled to or integrated with the ramped surface and configured to interface with the patient support device, wherein the directional guide material inhibits relative movement in a first direction between the patient support device and the positioning apparatus more than relative movement in a second direction between the patient support device and the positioning apparatus.