Qualitative Evaluation of Fiducial Markers for Radiotherapy Imaging

Overview

Journal Technol Cancer Res Treat

Specialties Biomedical Engineering
Oncology
Pharmacology

Date 2014 Sep 19

PMID 25230715

Citations 22

Authors

Maria F Chan

Gilad N Cohen

Joseph O Deasy

Affiliations

Soon will be listed here.

Abstract

Purpose: To evaluate visibility, artifacts, and distortions of various commercial markers in magnetic resonance imaging (MRI), computer tomography (CT), and ultrasound imaging used for radiotherapy planning and treatment guidance.

Methods: We compare 2 solid gold markers, 4 gold coils, and 1 polymer marker from 3 vendors. Imaging modalities used were 3-T and 1.5-T GE MRIs, Siemens Sequoia 512 Ultrasound, Phillips Big Bore CT, Varian Trilogy linear accelerator (cone-beam CT [CBCT], on-board imager kilovoltage [OBI-kV], electronic portal imaging device megavoltage [EPID-MV]), and Medtronic O-ARM CBCT. Markers were imaged in a 30 × 30 × 10 cm(3) custom bolus phantom. In one experiment, Surgilube was used around the markers to reduce air gaps. Images were saved in Digital Imaging and Communications in Medicine (DICOM) format and analyzed using an in-house software. Profiles across the markers were used for objective comparison of the markers' signals. The visibility and artifacts/distortions produced by each marker were assessed qualitatively and quantitatively.

Results: All markers are visible in CT, CBCT, OBI-kV, and ultrasound. Gold markers below 0.75 mm in diameter are not visible in EPID-MV images. The larger the markers, the more CT and CBCT image artifacts there are, yet the degree of the artifact depends on scan parameters and the scanner itself. Visibility of gold coils of 0.75 mm diameter or larger is comparable across all imaging modalities studied. The polymer marker causes minimal artifacts in CT and CBCT but has poor visibility in EPID-MV. Gold coils of 0.5 mm exhibit poor visibility in MRI and EPID-MV due to their small size. Gold markers are more visible in 3-T T1 gradient-recalled echo than in 1.5-T T1 fast spin-echo, depending on the scan sequence. In this study, all markers are clearly visible on ultrasound.

Conclusion: All gold markers are visible in CT, CBCT, kV, and ultrasound; however, only the large diameter markers are visible in MV. When MR and EPID-MV imagers are used, the selection of fiducial markers is not straightforward. For hybrid kV/MV image-guided radiotherapy imaging, larger diameter markers are suggested. If using kV imaging alone, smaller sized markers may be used in smaller sized patients in order to reduce artifacts. Only larger diameter gold markers are visible across all imaging modalities.

Citing Articles

Feasibility and guidelines for the use of an injectable fiducial marker (BioXmark ) to improve target delineation in preclinical radiotherapy studies using mouse models.

Brown K, Ghita M, Prise K, Butterworth K F1000Res. 2024; 12:526.

PMID: 38799243 PMC: 11116939. DOI: 10.12688/f1000research.130883.1.

Smart Radiotherapy Biomaterials for Image-Guided In Situ Cancer Vaccination.

Ainsworth V, Moreau M, Guthier R, Zegeye Y, Kozono D, Swanson W Nanomaterials (Basel). 2023; 13(12).

PMID: 37368273 PMC: 10303169. DOI: 10.3390/nano13121844.

A clinical study comparing polymer and gold fiducials for prostate cancer radiotherapy.

Joon D, Berry C, Harris B, Tacey M, Smith D, Lawrentschuk N Front Oncol. 2023; 12:1023288.

PMID: 36818674 PMC: 9930895. DOI: 10.3389/fonc.2022.1023288.

A liquid immunogenic fiducial eluter for image-guided radiotherapy.

Moreau M, Richards G, Yasmin-Karim S, Narang A, Deville Jr C, Ngwa W Front Oncol. 2023; 12:1020088.

PMID: 36620560 PMC: 9812550. DOI: 10.3389/fonc.2022.1020088.

Long-Term In Vitro Assessment of Biodegradable Radiopaque Composites for Fiducial Marker Fabrication.

Gorecka Z, Choinska E, Heljak M, Swieszkowski W Int J Mol Sci. 2022; 23(22).

PMID: 36430842 PMC: 9697335. DOI: 10.3390/ijms232214363.

References

van der Wielen G, Mutanga T, Incrocci L, Kirkels W, Vasquez Osorio E, Hoogeman M . Deformation of prostate and seminal vesicles relative to intraprostatic fiducial markers. Int J Radiat Oncol Biol Phys. 2008; 72(5):1604-1611.e3. DOI: 10.1016/j.ijrobp.2008.07.023. View

Henry A, Stratford J, Davies J, McCarthy C, Swindell R, Sykes J . An assessment of clinically optimal gold marker length and diameter for pelvic radiotherapy verification using an amorphous silicon flat panel electronic portal imaging device. Br J Radiol. 2005; 78(932):737-41. DOI: 10.1259/bjr/97956788. View

Welsh J, Berta C, Borzillary S, Sam C, Shickell D, Nobile L . Fiducial markers implanted during prostate brachytherapy for guiding conformal external beam radiation therapy. Technol Cancer Res Treat. 2004; 3(4):359-64. DOI: 10.1177/153303460400300405. View

Gauthier I, Carrier J, Beliveau-Nadeau D, Fortin B, Taussky D . Dosimetric impact and theoretical clinical benefits of fiducial markers for dose escalated prostate cancer radiation treatment. Int J Radiat Oncol Biol Phys. 2009; 74(4):1128-33. DOI: 10.1016/j.ijrobp.2008.09.043. View

Skarsgard D, Cadman P, El-Gayed A, Pearcey R, Tai P, Pervez N . Planning target volume margins for prostate radiotherapy using daily electronic portal imaging and implanted fiducial markers. Radiat Oncol. 2010; 5:52. PMC: 2896366. DOI: 10.1186/1748-717X-5-52. View

Jonsson J, Garpebring A, Karlsson M, Nyholm T . Internal fiducial markers and susceptibility effects in MRI-simulation and measurement of spatial accuracy. Int J Radiat Oncol Biol Phys. 2011; 82(5):1612-8. DOI: 10.1016/j.ijrobp.2011.01.046. View

Kothary N, Dieterich S, Louie J, Chang D, Hofmann L, Sze D . Percutaneous implantation of fiducial markers for imaging-guided radiation therapy. AJR Am J Roentgenol. 2009; 192(4):1090-6. DOI: 10.2214/AJR.08.1399. View

Chen Y, OConnell J, Ko C, Mayer R, Belard A, McDonough J . Fiducial markers in prostate for kV imaging: quantification of visibility and optimization of imaging conditions. Phys Med Biol. 2011; 57(1):155-72. DOI: 10.1088/0031-9155/57/1/155. View

Huang J, Newhauser W, Zhu X, Lee A, Kudchadker R . Investigation of dose perturbations and the radiographic visibility of potential fiducials for proton radiation therapy of the prostate. Phys Med Biol. 2011; 56(16):5287-302. PMC: 3171138. DOI: 10.1088/0031-9155/56/16/014. View

10.

Huang E, Dong L, Chandra A, Kuban D, Rosen I, Evans A . Intrafraction prostate motion during IMRT for prostate cancer. Int J Radiat Oncol Biol Phys. 2002; 53(2):261-8. DOI: 10.1016/s0360-3016(02)02738-4. View

11.

Adjamian P, Barnes G, Hillebrand A, Holliday I, Singh K, Furlong P . Co-registration of magnetoencephalography with magnetic resonance imaging using bite-bar-based fiducials and surface-matching. Clin Neurophysiol. 2004; 115(3):691-8. DOI: 10.1016/j.clinph.2003.10.023. View

12.

Erickson B, Jack Jr C . Correlation of single photon emission CT with MR image data using fiduciary markers. AJNR Am J Neuroradiol. 1993; 14(3):713-20. PMC: 8333382. View

13.

Khosa R, Nangia S, Chufal K, Ghosh D, Kaul R, Sharma L . Daily online localization using implanted fiducial markers and its impact on planning target volume for carcinoma prostate. J Cancer Res Ther. 2010; 6(2):172-8. DOI: 10.4103/0973-1482.65244. View

14.

Cheung J, Kudchadker R, Zhu X, Lee A, Newhauser W . Dose perturbations and image artifacts caused by carbon-coated ceramic and stainless steel fiducials used in proton therapy for prostate cancer. Phys Med Biol. 2010; 55(23):7135-47. DOI: 10.1088/0031-9155/55/23/S13. View

15.

Schiffner D, Gottschalk A, Lometti M, Aubin M, Pouliot J, Speight J . Daily electronic portal imaging of implanted gold seed fiducials in patients undergoing radiotherapy after radical prostatectomy. Int J Radiat Oncol Biol Phys. 2007; 67(2):610-9. DOI: 10.1016/j.ijrobp.2006.09.042. View

16.

Britton K, Takai Y, Mitsuya M, Nemoto K, Ogawa Y, Yamada S . Evaluation of inter- and intrafraction organ motion during intensity modulated radiation therapy (IMRT) for localized prostate cancer measured by a newly developed on-board image-guided system. Radiat Med. 2005; 23(1):14-24. View

17.

Huisman H, Futterer J, van Lin E, Welmers A, Scheenen T, van Dalen J . Prostate cancer: precision of integrating functional MR imaging with radiation therapy treatment by using fiducial gold markers. Radiology. 2005; 236(1):311-7. DOI: 10.1148/radiol.2361040560. View

18.

Barney B, Lee R, Handrahan D, Welsh K, Cook J, Sause W . Image-guided radiotherapy (IGRT) for prostate cancer comparing kV imaging of fiducial markers with cone beam computed tomography (CBCT). Int J Radiat Oncol Biol Phys. 2010; 80(1):301-5. DOI: 10.1016/j.ijrobp.2010.06.007. View

19.

Yue N, Patel A, Haffty B, Kim S . Efficacy of fiducial marker-based image-guided radiation therapy in prostate tomotherapy and potential dose coverage improvement using a patient positioning optimization method. Pract Radiat Oncol. 2014; 2(2):138-44. DOI: 10.1016/j.prro.2011.07.006. View

20.

Handsfield L, Yue N, Zhou J, Chen T, Goyal S . Determination of optimal fiducial marker across image-guided radiation therapy (IGRT) modalities: visibility and artifact analysis of gold, carbon, and polymer fiducial markers. J Appl Clin Med Phys. 2012; 13(5):3976. PMC: 5718239. DOI: 10.1120/jacmp.v13i5.3976. View