title: Novel technique for hepatic fiducial marker placement for stereotactic body radiation therapy.
abstract: OBJECTIVE
  To report experience with fiducial marker insertion and describe an advantageous, novel technique for fiducial placement in the liver for stereotactic body radiation therapy with respiratory tracking.
  
  
  METHODS
  We implanted 1444 fiducials (single: 834; linked: 610) in 328 patients with 424 hepatic lesions. Two methods of implantation were compared: the standard method (631 single fiducials) performed on 153 patients from May 2007 to May 2010, and the cube method (813 fiducials: 610 linked/203 single) applied to 175 patients from April 2010 to March 2013. The standard method involved implanting a single marker at a time. The novel technique entailed implanting 2 pairs of linked markers when possible in a way to occupy the perpendicular edges of a cube containing the tumor inside.
  
  
  RESULTS
  Mean duration of the cube method was shorter than the standard method (46 vs 61 minutes; P<.0001). Median numbers of skin and subcapsular entries were significantly smaller with the cube method (2 vs 4, P<.0001, and 2 vs 4, P<.0001, respectively). The rate of overall complications (total, major, and minor) was significantly lower in the cube method group compared with the standard method group (5.7% vs 13.7%; P=.013). Major complications occurred while using single markers only. The success rate was 98.9% for the cube method and 99.3% for the standard method.
  
  
  CONCLUSIONS
  We propose a new technique of hepatic fiducial implantation that makes use of linked fiducials and involves fewer skin entries and shorter time of implantation. The technique is less complication-prone and is migration-resistant.
authors.affiliation: Academic Department of Radiology, Oncologic Center Oscar Lambret, Lille, France. Electronic address: h-jarraya@o-lambret.fr.
authors.forename: Hajer
authors.initials: H
authors.lastname: Jarraya
authors.affiliation: Academic Department of Radiology, Oncologic Center Oscar Lambret, Lille, France.
authors.forename: Chloé
authors.initials: C
authors.lastname: Chalayer
authors.affiliation: Department of Biostatistics, Oncologic Center Oscar Lambret, Lille, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Tresch
authors.affiliation: Academic Department of Radiology, Oncologic Center Oscar Lambret, Lille, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Bonodeau
authors.affiliation: Department of Radiotherapy, Oncologic Center Oscar Lambret, Lille, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lacornerie
authors.affiliation: Department of Radiotherapy, Oncologic Center Oscar Lambret, Lille, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Mirabel
authors.affiliation: Academic Department of Radiology, Oncologic Center Oscar Lambret, Lille, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Boulanger
authors.affiliation: Academic Department of Radiology, Oncologic Center Oscar Lambret, Lille, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Taieb
authors.affiliation: Department of Biostatistics, Oncologic Center Oscar Lambret, Lille, France.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kramar
authors.affiliation: Department of Radiotherapy, Oncologic Center Oscar Lambret, Lille, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Lartigau
authors.affiliation: Academic Department of Radiology, Oncologic Center Oscar Lambret, Lille, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Ceugnart
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D057918:Fiducial Markers / Q000009:adverse effects; D005548:Foreign-Body Migration; D006801:Humans; D008099:Liver; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009068:Movement; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D016634:Radiosurgery / Q000295:instrumentation* / Q000379:methods; D061089:Radiotherapy, Image-Guided / Q000295:instrumentation; D012119:Respiration; D013997:Time Factors; D055815:Young Adult