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Review
. 2018 Mar;10(3):1972-1983.
doi: 10.21037/jtd.2018.03.49.

Fiducial marker placement for stereotactic body radiation therapy via convex probe endobronchial ultrasound: a case series and review of literature

Benjamin J Seides  1 , John P Egan 3rd  2   3   4 , Kim D French  2   3 , Kevin L Kovitz  2   3   4 , Neeraj R Desai  2   3   4
Affiliations
Review

Fiducial marker placement for stereotactic body radiation therapy via convex probe endobronchial ultrasound: a case series and review of literature

Benjamin J Seides et al. J Thorac Dis. 2018 Mar.

Abstract

Convex probe endobronchial ultrasound (CP-EBUS) and stereotactic body radiotherapy (SBRT) are valuable tools in the diagnosis, staging, and treatment of thoracic malignancies. With widespread clinical adoption, novel uses of CP-EBUS beyond mediastinal diagnosis and staging continue to be discovered. SBRT is an attractive treatment strategy in early-stage lung cancer and oligo-metastatic disease of the chest when a surgical approach is either not feasible or desirable. Accurate application of SBRT is aided by the placement of radio-opaque fiducial markers (FM) to compensate for respiratory cycle movements. We describe eight patients with central thoracic lesions, either known or suspected to be malignant, who underwent EBUS bronchoscopy with lesion sampling and successful intralesional placement of modified FM via our technique, review the existing literature on this topic, and discuss the nuances of coding and billing aspects of FM placement.

Keywords: Endobronchial ultrasound (EBUS); fiducial markers (FMs); lung cancer; stereotactic body radiation therapy (SBRT).

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Loading fiducial marker into the TBNA needle. (A) EBUS needle and partially withdrawn stylet; (B) intact visicoil FM; (C) back loading modified FM; (D) partially loaded FM and bone wax used to seal the tip. TBNA, transbronchial needle aspiration; EBUS, endobronchial ultrasound; FM, fiducial marker.
Figure 2
Figure 2
(A) EBUS needle in the hilar lesion with deployed FM visible distal to the needle tip; (B) CT scan of the chest 6 months after SBRT showing FM in good position. EBUS, endobronchial ultrasound; FM, fiducial marker; SBRT, stereotactic body radiotherapy.
Figure 3
Figure 3
SBRT planning images showing contours to delineate target lesion and surrounding structures. SBRT, stereotactic body radiotherapy.
Figure 4
Figure 4
SBRT planning images showing the dosimetry plan to the target lesion and the surrounding structures. SBRT, stereotactic body radiotherapy.
See this image and copyright information in PMC

References

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