Safety and Efficacy of Percutaneous Fiducial Marker Implantation for Image-guided Radiation Therapy

Kothary, Nishita; Heit, Jeremy J; Louie, John D.; Kuo, William T.; Loo, Billy W.; Koong, Albert C.; Chang, Daniel T.; Hovsepian, David M.; Sze, Daniel Y.; Hofmann, Lawrence V.

doi:10.1016/j.jvir.2008.09.026

Cited by 175 publications

(143 citation statements)

References 31 publications

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“…( 8 , 10 ) Smooth cylindrical gold seed markers (Alpha‐Omega Services, Bellflower, CA) and platinum endovascular embolization coils (VortX 18 Vascular Occlusion Coil, Boston Scientific Corp., Natick, MA) were used as fiducial markers. Seeds were 0.8 mm in diameter by 5 mm in length and were delivered via 19‐gauge thin‐wall coaxial introducer needle.…”

Section: Methodsmentioning

confidence: 99%

Migration of implanted markers for image‐guided lung tumor stereotactic ablative radiotherapy

Hong

Eclov

et al. 2013

J Applied Clin Med Phys

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The purpose of this study was to quantify postimplantation migration of percutaneously implanted cylindrical gold seeds (“seeds”) and platinum endovascular embolization coils (“coils”) for tumor tracking in pulmonary stereotactic ablative radiotherapy (SABR). We retrospectively analyzed the migration of markers in 32 consecutive patients with computed tomography scans postimplantation and at simulation. We implanted 147 markers (59 seeds, 88 coils) in or around 34 pulmonary tumors over 32 procedures, with one lesion implanted twice. Marker coordinates were rigidly aligned by minimizing fiducial registration error (FRE), the root mean square of the differences in marker locations for each tumor between scans. To also evaluate whether single markers were responsible for most migration, we aligned with and without the outlier causing the largest FRE increase per tumor. We applied the resultant transformation to all markers. We evaluated migration of individual markers and FRE of each group. Median scan interval was 8 days. Median individual marker migration was 1.28 mm (interquartile range [IQR] 0.78−2.63 mm). Median lesion FRE was 1.56 mm (IQR 0.92−2.95 mm). Outlier identification yielded 1.03 mm median migration (IQR 0.52−2.21 mm) and 1.97 mm median FRE (IQR 1.44−4.32 mm). Outliers caused a mean and median shift in the centroid of 1.22 and 0.80 mm (95th percentile 2.52 mm). Seeds and coils had no statistically significant difference. Univariate analysis suggested no correlation of migration with the number of markers, contact with the chest wall, or time elapsed. Marker migration between implantation and simulation is limited and unlikely to cause geometric miss during tracking.PACS number: 87.57.N‐; 87.57.nm; 87.53.Ly

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Section: Methodsmentioning

confidence: 99%

Migration of implanted markers for image‐guided lung tumor stereotactic ablative radiotherapy

Hong

Eclov

et al. 2013

J Applied Clin Med Phys

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“…The risk of pneumothorax from the marker implantation also prompted researchers to explore the possibility of markerless tumor tracking 12. While most studies on tumor tracking have been focused on tracking algorithms,8, 9, 10, 11 the importance of consecutive image display on EPID cannot be neglected.…”

Section: Introductionmentioning

confidence: 99%

Enhancement of megavoltage electronic portal images for markerless tumor tracking

Cheong

Yoon

Park

et al. 2018

J Applied Clin Med Phys

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PurposeThe poor quality of megavoltage (MV) images from electronic portal imaging device (EPID) hinders visual verification of tumor targeting accuracy particularly during markerless tumor tracking. The aim of this study was to investigate the effect of a few representative image processing treatments on visual verification and detection capability of tumors under auto tracking.MethodsImages of QC‐3 quality phantom, a single patient's setup image, and cine images of two‐lung cancer patients were acquired. Three image processing methods were individually employed to the same original images. For each deblurring, contrast enhancement, and denoising, a total variation deconvolution, contrast‐limited adaptive histogram equalization (CLAHE), and median filter were adopted, respectively. To study the effect of image enhancement on tumor auto‐detection, a tumor tracking algorithm was adopted in which the tumor position was determined as the minimum point of the mean of the sum of squared pixel differences (MSSD) between two images. The detectability and accuracy were compared.ResultsDeblurring of a quality phantom image yielded sharper edges, while the contrast‐enhanced image was more readable with improved structural differentiation. Meanwhile, the denoising operation resulted in noise reduction, however, at the cost of sharpness. Based on comparison of pixel value profiles, contrast enhancement outperformed others in image perception. During the tracking experiment, only contrast enhancement resulted in tumor detection in all images using our tracking algorithm. Deblurring failed to determine the target position in two frames out of a total of 75 images. For original and denoised set, target location was not determined for the same five images. Meanwhile, deblurred image showed increased detection accuracy compared with the original set. The denoised image resulted in decreased accuracy. In the case of contrast‐improved set, the tracking accuracy was nearly maintained as that of the original image.ConclusionsConsidering the effect of each processing on tumor tracking and the visual perception in a limited time, contrast enhancement would be the first consideration to visually verify the tracking accuracy of tumors on MV EPID without sacrificing tumor detectability and detection accuracy.

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“…In systems where 2-D imaging is used for image guidance, metallic fiducial markers are frequently placed in and around the tumour to help with tumour localisation and tracking during the treatment (23). Patients are simulated using a highquality, 4-dimensional CT (4D-CT), which assesses tumour position at each phase of the respiratory cycle (24).…”

Section: Sabr Techniquementioning

confidence: 99%

Selenium Protects Retinal Cells from Cisplatin Induced Alterations in Carbohydrate Residues

Akşit¹,

Yazıcı²,

Akşit³

et al. 2015

Balkan Med J

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Non-small cell lung cancer (NSCLC) remains the leading cause of cancer death worldwide. Approximately 15 to 20% of NSCLC patients present with early or localised disease; this figure is expected to grow with the increased use of low-dose computed tomography (CT) scans for screening (1). The standard treatment for operable stage I NSCLC is lobectomy or pneumonectomy with mediastinal lymphadenectomy. Five-year survival rates of early stage NSCLC patients range between 60 and 80% after surgical resection (2). Despite major developments in minimally-invasive surgical procedures, a substantial proportion of patients are not suitable for surgery due to their comorbidities. Stereotactic body radiation therapy (SBRT) or stereotactic ablative radiotherapy (SABR) has recently emerged as a benchmark of care for medically inoperable patients. SABR is a more concise and well-planned treatment procedure with enhanced local control and survival while minimising treatment cost against conventional radiotherapy.Cancer-specific outcomes of patients in SABR series are generally comparable to surgical series; however, overall survival results are usually reported to be superior in the surgical cohorts because of major differences in the two groups.Approximately one in every three patient dies as a result of comorbidity-related complications instead of cancer in SBRT series. As a result, in patients with operable stage I NSCLC, surgical operation continues to be the benchmark of care. In this review, we plan to summarise the published evidence for the treatment of early stage NSCLC with surgery and SABR. THE SURGICAL MANAGEMENT OF EARLY STAGE NSCLCSurgical resection remains the treatment of choice for patients with stage I or II NSCLC, since it provides the optimal likelihood of cure and long-term survival. Such an operation includes both complete anatomical resection of the tumour and mediastinal lymph node evaluation (3). PREOPERATIVE EVALUATIONPatients with NSCLC who are surgical candidates are often cigarette smokers, which makes them vulnerable to atheroThe management of early-stage Non-small Cell Lung Cancer (NSCLC) has improved recently due to advances in surgical and radiation modalities. Minimallyinvasive procedures like Video-assisted thoracoscopic surgery (VATS) lobectomy decreases the morbidity of surgery, while the numerous methods of staging the mediastinum such as endobronchial and endoscopic ultrasound-guided biopsies are helping to achieve the objectives much more effectively. Stereotactic Ablative Radiotherapy (SABR) has become the frontrunner as the standard of care in medically inoperable early stage NSCLC patients, and has also been branded as tolerable and highly effective. Ongoing researches using SABR are continuously validating the optimal dosing and fractionation schemes, while at the same time instituting its role for both inoperable and operable patients.

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Safety and Efficacy of Percutaneous Fiducial Marker Implantation for Image-guided Radiation Therapy

Cited by 175 publications

References 31 publications

Migration of implanted markers for image‐guided lung tumor stereotactic ablative radiotherapy

Migration of implanted markers for image‐guided lung tumor stereotactic ablative radiotherapy

Enhancement of megavoltage electronic portal images for markerless tumor tracking

Selenium Protects Retinal Cells from Cisplatin Induced Alterations in Carbohydrate Residues

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