Electromagnetic navigational bronchoscopy-guided fiducial markers for lung stereotactic body radiation therapy: Analysis of safety, feasibility, and interfraction stability

Nima Nabavizadeh, Junan Zhang, David A. Elliott, James A. Tanyi, Charles R. Thomas, Martin Fuss, Mark Deffebach

Research output: Contribution to journalArticle

35 Scopus citations

Abstract

Background: Embolization coils as fiducial markers for pulmonary stereotactic body radiation therapy (SBRT) are perceived to be the optimal marker type, given their ability to conform and anchor within the small airways. The aim of our study was to assess retention, placement, migration, feasibility, and safety of electromagnetic navigational bronchoscopy (ENB)-guided embolization coil markers throughout courses of SBRT. Methods: Thirty-one patients with 34 nodules underwent ENB-guided fiducial placement of several 4mm fibered platinum embolization coils before SBRT. Patient and nodule positioning was confirmed with daily pretreatment cone-beam computed tomography (CBCT). Fiducial positional characteristics were analyzed utilizing radiation treatment-planning software comparing the simulation CT with daily CBCTs. Results: Of 105 fiducials placed, 103 were identifiable on simulation CT (retention rate: 98.1%). Incidence of asymptomatic pneumothoraces was 6%. One patient experienced hemoptysis requiring hospitalization. Eighty-six percent of fiducials were placed within 1 cm of the nodule, with 52% of fiducials placed directly on the nodule surface. Throughout a 5-fraction SBRT course, fiducial displacement was <7, 5, and 2mm in 98%, 96%, and 67% of pretreatment CBCTs. Conclusions: ENB placement of embolization coils as fiducials for lung SBRT image guidance is associated with a low rate of iatrogenic pneumothoraces, and resulted in reliable placement of the fiducials in close proximity to the lung nodule. Embolization coils retained their relative position to the nodule throughout the course of SBRT, and provide an excellent alternative to linear gold seeds.

Original languageEnglish (US)
Pages (from-to)123-130
Number of pages8
JournalJournal of Bronchology and Interventional Pulmonology
Volume21
Issue number2
DOIs
StatePublished - Apr 2014

Keywords

  • Fiducials
  • Lung SBRT
  • Navigational bronchoscopy

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Fingerprint Dive into the research topics of 'Electromagnetic navigational bronchoscopy-guided fiducial markers for lung stereotactic body radiation therapy: Analysis of safety, feasibility, and interfraction stability'. Together they form a unique fingerprint.

  • Cite this