REGULAR CONTENT
Final ID
473
Type
Original Scientific Research-Oral or Pos
Authors
A Sharif1, A Patel1, M Hughes1, R Johnson1, S Gadani1, I Moreno1, M Mikhayel1, B Dang1, A Moiyadi1, K Vaheesan1
Institutions
1Saint Louis University, Saint Louis, MO
Purpose
Fiducials are implantable markers used in stereotactic ablative radiotherapy, which requires precise lesion localization. These markers enable lesion tracking and localization, but complications such pneumothoraces and migrations may occur. The purpose of this study is to analyze the migration rate of the fiducials and its implication on patient outcome.
Materials & Methods
We retrospectively analyzed 83 cases of percutaneously placed pulmonary single fiducial markers from 2009 to 2015. The analysis for migration was performed with the utilization of the hospital PACS system using a variety of imaging modalities including plain radiographs, CT and PET/ CT studies.
Results
Out of 83 cases analyzed, there were 23 incidents of fiducial migration. Migration was defined as any fiducial marker that moved out of its target lesion, either immediately or over time. In some instances, more than one migration was seen within the same patient. In 8 cases, the migration was within the same pulmonary lobe but away from the target lesion. 2 fiducials migrated to a different lobe, 1 to the contralateral lung, 4 into the pleural space, and 2 migrated into the abdomen. In 5 cases, some of the fiducials were missing from their original insertion site but their final destination could not be identified. The most clinically significant of all was 1 that migrated into the right coronary artery, resulting in myocardial infarction on the subsequent day.
Conclusions
In this retrospective study, a rate of 27.71% migration of single pulmonary fiducial markers is of utmost clinical significance. While the primary intention of these markers is to serve as a target site for stereotactic ablative radiotherapy, their migration may lead to inadvertent treatment of sites away from the target lesion, thereby resulting in treatment failure or disease progression. The physical migration of these single fiducial markers into critical regions such as the coronary arteries may also lead to detrimental patient outcome. Consequently, we hope that the study will cause more awareness on weighing the benefits and risks during the decision making process of stereotactic radiation treatment.
Final ID
473
Type
Original Scientific Research-Oral or Pos
Authors
A Sharif1, A Patel1, M Hughes1, R Johnson1, S Gadani1, I Moreno1, M Mikhayel1, B Dang1, A Moiyadi1, K Vaheesan1
Institutions
1Saint Louis University, Saint Louis, MO
Purpose
Fiducials are implantable markers used in stereotactic ablative radiotherapy, which requires precise lesion localization. These markers enable lesion tracking and localization, but complications such pneumothoraces and migrations may occur. The purpose of this study is to analyze the migration rate of the fiducials and its implication on patient outcome.
Materials & Methods
We retrospectively analyzed 83 cases of percutaneously placed pulmonary single fiducial markers from 2009 to 2015. The analysis for migration was performed with the utilization of the hospital PACS system using a variety of imaging modalities including plain radiographs, CT and PET/ CT studies.
Results
Out of 83 cases analyzed, there were 23 incidents of fiducial migration. Migration was defined as any fiducial marker that moved out of its target lesion, either immediately or over time. In some instances, more than one migration was seen within the same patient. In 8 cases, the migration was within the same pulmonary lobe but away from the target lesion. 2 fiducials migrated to a different lobe, 1 to the contralateral lung, 4 into the pleural space, and 2 migrated into the abdomen. In 5 cases, some of the fiducials were missing from their original insertion site but their final destination could not be identified. The most clinically significant of all was 1 that migrated into the right coronary artery, resulting in myocardial infarction on the subsequent day.
Conclusions
In this retrospective study, a rate of 27.71% migration of single pulmonary fiducial markers is of utmost clinical significance. While the primary intention of these markers is to serve as a target site for stereotactic ablative radiotherapy, their migration may lead to inadvertent treatment of sites away from the target lesion, thereby resulting in treatment failure or disease progression. The physical migration of these single fiducial markers into critical regions such as the coronary arteries may also lead to detrimental patient outcome. Consequently, we hope that the study will cause more awareness on weighing the benefits and risks during the decision making process of stereotactic radiation treatment.