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• W2096475304 abstract "Purpose/Objective(s)To evaluate the use of ultra-thin (.35 mm x 1 cm) fiducials for tumor localization in patients receiving image guided radiation therapy (IGRT) for intra-abdominal tumors, specifically, to review complications of fiducial placement, fiducial migration, and fiducial visualization on kilovoltage imaging.Materials/MethodsWe performed a retrospective chart review on 19 consecutive patients with 22 tumors who underwent intra-abdominal fiducial placement with.35 mm x 1 cm fiducial markers (Visicoil Radiomed, Tyngsboro, MA) for the purpose of IGRT treatment planning between the dates of December 2006 and February 2009.ResultsTwenty-two fiducials were placed in preparation for IGRT of 10 primary tumors and 12 metastatic deposits within the abdomen. Thirteen fiducials were placed percutaneously via a 19 gauge needle under ultrasound (10 fiducials) or CT (3 fiducials) guidance. Nine were placed by gastroenterology through a 22 gauge needle with endoscopic ultrasound visualization. Fiducial targets were 14 tumors in the liver, 5 in the pancreas, and 1 in each of the following: adrenal gland, celiac lymph node, and subdiaphragmatic lymph node. Tumors ranged in size from 15 to 120 mm (mean 38.5 mm). Twenty-two fiducials (95%) were implanted within or near the tumor, with 1 subcapsular placement of a fiducial targeted at a liver tumor; all fiducials were confirmed to be in position on treatment planning CT. Complications were limited to an asymptomatic subcapsular liver hematoma in 1 patient (5%). Eighteen tumors were treated with stereotactic body radiation and 4 tumors with conventionally fractionated radiation therapy. There were no cases of fiducial migration noted during radiation therapy or on follow-up imaging available on 11 patients. Two fiducials (9%) were difficult to visualize on cone beam CT secondary to breathing motion. All fiducials were visible on lateral and AP/PA kilovoltage images on a Trilogy linear accelerator (Varian Medical Systems, Palo Alto, CA), and this information was used daily to set gating windows using fluoroscopy in 18 of 19 patients.ConclusionsUltra-thin fiducials can be used for IGRT of abdominal tumors with little difficulty. Fiducial implantation was done as outpatient procedure with no significant complications. The fiducials did not migrate and are easily identified on kilovoltage fluoroscopy using modern on-board imaging. Purpose/Objective(s)To evaluate the use of ultra-thin (.35 mm x 1 cm) fiducials for tumor localization in patients receiving image guided radiation therapy (IGRT) for intra-abdominal tumors, specifically, to review complications of fiducial placement, fiducial migration, and fiducial visualization on kilovoltage imaging. To evaluate the use of ultra-thin (.35 mm x 1 cm) fiducials for tumor localization in patients receiving image guided radiation therapy (IGRT) for intra-abdominal tumors, specifically, to review complications of fiducial placement, fiducial migration, and fiducial visualization on kilovoltage imaging. Materials/MethodsWe performed a retrospective chart review on 19 consecutive patients with 22 tumors who underwent intra-abdominal fiducial placement with.35 mm x 1 cm fiducial markers (Visicoil Radiomed, Tyngsboro, MA) for the purpose of IGRT treatment planning between the dates of December 2006 and February 2009. We performed a retrospective chart review on 19 consecutive patients with 22 tumors who underwent intra-abdominal fiducial placement with.35 mm x 1 cm fiducial markers (Visicoil Radiomed, Tyngsboro, MA) for the purpose of IGRT treatment planning between the dates of December 2006 and February 2009. ResultsTwenty-two fiducials were placed in preparation for IGRT of 10 primary tumors and 12 metastatic deposits within the abdomen. Thirteen fiducials were placed percutaneously via a 19 gauge needle under ultrasound (10 fiducials) or CT (3 fiducials) guidance. Nine were placed by gastroenterology through a 22 gauge needle with endoscopic ultrasound visualization. Fiducial targets were 14 tumors in the liver, 5 in the pancreas, and 1 in each of the following: adrenal gland, celiac lymph node, and subdiaphragmatic lymph node. Tumors ranged in size from 15 to 120 mm (mean 38.5 mm). Twenty-two fiducials (95%) were implanted within or near the tumor, with 1 subcapsular placement of a fiducial targeted at a liver tumor; all fiducials were confirmed to be in position on treatment planning CT. Complications were limited to an asymptomatic subcapsular liver hematoma in 1 patient (5%). Eighteen tumors were treated with stereotactic body radiation and 4 tumors with conventionally fractionated radiation therapy. There were no cases of fiducial migration noted during radiation therapy or on follow-up imaging available on 11 patients. Two fiducials (9%) were difficult to visualize on cone beam CT secondary to breathing motion. All fiducials were visible on lateral and AP/PA kilovoltage images on a Trilogy linear accelerator (Varian Medical Systems, Palo Alto, CA), and this information was used daily to set gating windows using fluoroscopy in 18 of 19 patients. Twenty-two fiducials were placed in preparation for IGRT of 10 primary tumors and 12 metastatic deposits within the abdomen. Thirteen fiducials were placed percutaneously via a 19 gauge needle under ultrasound (10 fiducials) or CT (3 fiducials) guidance. Nine were placed by gastroenterology through a 22 gauge needle with endoscopic ultrasound visualization. Fiducial targets were 14 tumors in the liver, 5 in the pancreas, and 1 in each of the following: adrenal gland, celiac lymph node, and subdiaphragmatic lymph node. Tumors ranged in size from 15 to 120 mm (mean 38.5 mm). Twenty-two fiducials (95%) were implanted within or near the tumor, with 1 subcapsular placement of a fiducial targeted at a liver tumor; all fiducials were confirmed to be in position on treatment planning CT. Complications were limited to an asymptomatic subcapsular liver hematoma in 1 patient (5%). Eighteen tumors were treated with stereotactic body radiation and 4 tumors with conventionally fractionated radiation therapy. There were no cases of fiducial migration noted during radiation therapy or on follow-up imaging available on 11 patients. Two fiducials (9%) were difficult to visualize on cone beam CT secondary to breathing motion. All fiducials were visible on lateral and AP/PA kilovoltage images on a Trilogy linear accelerator (Varian Medical Systems, Palo Alto, CA), and this information was used daily to set gating windows using fluoroscopy in 18 of 19 patients. ConclusionsUltra-thin fiducials can be used for IGRT of abdominal tumors with little difficulty. Fiducial implantation was done as outpatient procedure with no significant complications. The fiducials did not migrate and are easily identified on kilovoltage fluoroscopy using modern on-board imaging. Ultra-thin fiducials can be used for IGRT of abdominal tumors with little difficulty. Fiducial implantation was done as outpatient procedure with no significant complications. The fiducials did not migrate and are easily identified on kilovoltage fluoroscopy using modern on-board imaging." @default.
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• W2096475304 title "Tumor Localization with Ultra-thin Fiducials for Abdominal Radiation Therapy" @default.
• W2096475304 doi "https://doi.org/10.1016/j.ijrobp.2009.07.1347" @default.
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