title: CT fluoroscopy-guided percutaneous fiducial marker placement for CyberKnife stereotactic radiosurgery: technical results and complications in 222 consecutive procedures.
abstract: OBJECTIVE
  To evaluate technical outcome and safety of computed tomographic (CT) fluoroscopy-guided percutaneous fiducial marker placement before CyberKnife stereotactic radiosurgery.
  
  
  METHODS
  Retrospective analysis was performed of 196 patients (106 men) undergoing CT fluoroscopy-guided fiducial marker placement in 222 consecutive procedures under local anesthesia from March 2006 to February 2012. Technical success was defined as fiducial marker location in the tumor or vicinity suitable for CyberKnife radiosurgery evaluated on postinterventional planning CT. Complications were classified per Society of Interventional Radiology (SIR).
  
  
  RESULTS
  One hundred ninety-six patients (age, 61.5 y ± 13.1) underwent percutaneous placement of 321 fiducial markers (mean per tumor, 1.2 ± 0.5; range, 1-4) in 37 primary tumors and 227 metastases in the thorax (n = 121), abdomen (n = 122), and bone (n = 21). Fiducial marker placement was technically successful in all procedures: intratumoral localization in 193 (60.1%), at tumor margin in 50 (15.6%), and outside of tumor in 78 cases (24.3%; mean distance to marker, 0.4 cm ± 0.6; range, 0-2.9 cm). Complications were observed in 63 placement procedures (28.4%), including minor self-limiting pneumothorax (n = 21; SIR class B) and self-limiting pulmonary hemorrhage (n = 35; SIR class A), and major pneumothorax requiring thoracostomy/drainage insertion (n = 14; SIR class D) and systemic toxicity of local anesthetic drug (n = 1; SIR class D).
  
  
  CONCLUSIONS
  CT fluoroscopy-guided percutaneous fiducial marker placement can be performed with high technical success under local anesthesia in various anatomic regions. Although self-limiting in most cases, pneumothorax and pulmonary hemorrhage are frequently observed during fiducial marker implantation into lung tumors.
authors: Department of Clinical Radiology, Ludwig-Maximilians-University, Munich. Electronic address: christoph.trumm@med.lmu.de.
authors: Christoph G
authors: CG
authors: Trumm
authors: Department of Clinical Radiology, Ludwig-Maximilians-University, Munich.
authors: Sophia M
authors: SM
authors: Häussler
authors: European CyberKnife Center Munich, Barmherzige Brüder Hospital Munich, Munich.
authors: Alexander
authors: A
authors: Muacevic
authors: Department of Clinical Radiology, Ludwig-Maximilians-University, Munich.
authors: Robert
authors: R
authors: Stahl
authors: Norris Cancer Center, University of Southern California, Los Angeles, California.
authors: Sebastian
authors: S
authors: Stintzing
authors: Department of Clinical Radiology, Ludwig-Maximilians-University, Munich.
authors: Philipp M
authors: PM
authors: Paprottka
authors: Department of Clinical Radiology, Ludwig-Maximilians-University, Munich.
authors: Frederik
authors: F
authors: Strobl
authors: Department of Radiology, Barmherzige Brüder Hospital Munich, Munich.
authors: Tobias F
authors: TF
authors: Jakobs
authors: Department of Clinical Radiology, Ludwig-Maximilians-University, Munich.
authors: Maximilian F
authors: MF
authors: Reiser
authors: Department and Policlinics of Diagnostic Radiology, Carl Gustav Carus University Dresden, Dresden, Germany.
authors: Ralf-Thorsten
authors: RT
authors: Hoffmann
mesh_terms: D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D057918:Fiducial Markers; D006801:Humans; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000175:diagnosis / Q000209:etiology*; D016634:Radiosurgery / Q000009:adverse effects* / Q000295:instrumentation*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed / Q000295:instrumentation*; D016896:Treatment Outcome