title: Assessment of prostatic fiducial marker introduction: patient morbidity, staff satisfaction and improved treatment field placement.
abstract: BACKGROUND
  Increased accuracy when using fiducial markers for prostate localisation is well documented. This project aimed to establish the improvement in accuracy when using gold markers for daily prostate localisation, to assess patient satisfaction and morbidity from the transrectal implantation of gold seed markers and establish staff attitudes towards the newly introduced processes.
  
  
  METHODS
  Twenty patients with prostate cancer had three gold seeds implanted into the base, apex and central zone of the prostate transrectally using ultrasound guidance. Surveys were conducted to assess staff and patient satisfaction with the process of gold seed localisation. The gold markers were used to localise the prostate on a daily basis using megavoltage electronic portal imaging. Measurements were taken to establish the increase in accuracy when using gold fiducial markers compared with using the surrounding bony anatomy.
  
  
  RESULTS
  Inter-fraction motion (1 standard deviation (SD)) of the fiducial markers was 2.20, 4.28 and 4.27 mm in the LR, SI and AP directions, respectively. Intra-fraction prostate motion (1 SD) was measured as 0.8 mm LR, 1.1 mm SI and 2.0 mm AP. The patient survey showed that the insertion and associated side effects were acceptable, with 5% of patients stating that the seed insertion was worse than the prostate biopsy, and 23.1% of patients experienced short duration (1-2 days) haematuria. The staff survey showed that daily online image guidance was achievable without affecting patient throughput. Thirty percent of treatment staff believed that performing online daily localisation did not add any extra time to a standard treatment, and the remaining 70% thought that the added time was minimal (2-4 min).
  
  
  CONCLUSIONS
  Gold fiducial markers are an accurate, reliable and tolerable method of daily prostate localisation.
authors.affiliation: Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia. simon_a_brown@health.qld.gov.au
authors.forename: Simon
authors.initials: S
authors.lastname: Brown
authors.forename: Margot
authors.initials: M
authors.lastname: Lehman
authors.forename: Janet
authors.initials: J
authors.lastname: Ferrari-Anderson
authors.forename: Alan
authors.initials: A
authors.lastname: Glyde
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Burmeister
authors.forename: David
authors.initials: D
authors.lastname: Nicol
mesh_terms: D057918:Fiducial Markers; D006046:Gold; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D018084:Ultrasonography, Interventional
chemical_list: D006046:Gold