title: Complications of thoracic computed tomography-guided fiducial placement for the purpose of stereotactic body radiation therapy.
abstract: OBJECTIVE
  This study examined the complication rates associated with percutaneous fiducial placement for the purpose of stereotactic body radiation therapy of primary and metastatic lung neoplasms.
  
  
  METHODS
  This is a retrospective review of computed tomography (CT) scans and follow-up chest radiographs of 48 consecutive patients who underwent CT-guided percutaneous fiducial placement. The effect of age, sex, number of fiducials placed, and performance of a concomitant biopsy on the complication rates were assessed.
  
  
  RESULTS
  Of 48 patients with a total of 221 fiducials placed, 16 (33%) had a procedure-related pneumothorax. There was no significant difference in pneumothorax rate based on age (P = 0.16), sex (P > 0.99), and number of fiducials placed (P = 0.21). Overall, 6 of 48 patients (12.5%) required a thoracostomy tube. Performance of a concomitant core needle biopsy at the time of fiducial placement was associated with pneumothorax rates of 64% compared with 26% without biopsies (P = 0.03). Postprocedural CT demonstrated hemorrhage in 9 patients (19%). Two patients had hemoptysis; one required admission. Patients' age, sex, number of fiducials placed, and performance of concomitant biopsy had no statistically significant implications on parenchymal hemorrhage incidence.
  
  
  CONCLUSIONS
  Approximately one third of the patients develop a pneumothorax during CT-guided fiducial placement. Most are asymptomatic and do not require a thoracostomy. A concurrent biopsy at the time of fiducial placement is associated with an increased risk of pneumothorax. Hemorrhage occurs but is usually clinically insignificant.
authors.affiliation: Department of Radiology, Georgetown University Hospital, Washington, DC 20007-2113, USA.
authors.forename: Shadi
authors.initials: S
authors.lastname: Yousefi
authors.forename: Brian T
authors.initials: BT
authors.lastname: Collins
authors.forename: Cristina A
authors.initials: CA
authors.lastname: Reichner
authors.forename: Eric D
authors.initials: ED
authors.lastname: Anderson
authors.forename: Carlos
authors.initials: C
authors.lastname: Jamis-Dow
authors.forename: Gregory
authors.initials: G
authors.lastname: Gagnon
authors.forename: Shakun
authors.initials: S
authors.lastname: Malik
authors.forename: Blair
authors.initials: B
authors.lastname: Marshall
authors.forename: Thomas
authors.initials: T
authors.lastname: Chang
authors.forename: Filip
authors.initials: F
authors.lastname: Banovac
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000209:etiology; D013902:Radiography, Thoracic; D016634:Radiosurgery / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed