Fiducial marker placement is an image-guided procedure often performed by a urologist in preparation for proton therapy. Fiducial markers are small metal (typically gold) spheres, coils or cylinders about the size of a grain of rice that are placed in the prostate to help guide the placement of radiation beams during treatment.
Fiducial markers are implanted to define and target lesions located within the prostate.
Prior to your procedure, your blood may be tested to determine how well your kidneys are functioning and whether your blood clots normally.
You should report to your doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to local anaesthetic medications, general anaesthesia or to contrast materials containing iodine (sometimes referred to as “dye” or “x-ray dye”). Your physician may advise you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners for a specified period of time before your procedure.
Also inform your doctor about recent illnesses or other medical conditions.
You will receive specific instructions on how to prepare, including any changes that need to be made to your regular medication schedule. Other than medications, you may be instructed to not eat or drink anything for several hours before your procedure.
You may be asked to remove some or all of your clothes and to wear a gown during the exam. You may also be asked to remove jewellery, eye glasses and any metal objects or clothing that might interfere with the x-ray images.
You should plan to have a relative or friend drive you home after your procedure.
Fiducial markers are implanted using a delivery device that looks similar to a biopsy needle. Placement of fiducial markers is guided by computed tomography (CT) or ultrasound and may also involve the use of an endoscope, an illuminated optical instrument.
Fiducial markers are placed using a needle that is inserted into the area of the lesion with the help of computed tomography (CT) or ultrasound (US). Markers pre-filled in the needle are then advanced to carefully plotted positions in and around the tumour.
The placement of fiducial markers is typically performed as an outpatient procedure (several) days before treatment planning begins.
Before the procedure begins, imaging may be performed.
You will lie on the procedure table.
The doctor or nurse may connect you to monitors that track your heart rate, blood pressure, oxygen level, and pulse.
You may also be given pre-procedure antibiotics. Typically antibiotics are given for transrectal ultrasound-guided prostate seed placement.
Your doctor will numb the area with a local anaesthetic. This may briefly burn or sting before the area becomes numb.
The doctor will make a very small skin incision at the site.
Using computed tomography (CT) or ultrasound (US) guidance, the needle is inserted and advanced to the site of the lesion and at least three markers are implanted in and around the tumour to establish positional information. The type of imaging and number of markers used depend on the type and location of tumour being treated.
Once the marker placement is complete, the needle is removed.
Additional images may be taken to confirm the placement of fiducial markers. This procedure is usually completed within one hour. You may be required to stay in an area for observation for several hours.
You may feel some pressure when the pre-loaded needle is inserted, and the area of the needle insertion may possibly feel sore for a few days. If you have significant pain, your doctor may prescribe pain relief medication.
Aftercare instructions vary. However, generally you may bathe or shower as normal.
The use of fiducial markers helps pinpoint the location of a tumour with greater accuracy, enabling a treatment team to deliver the maximum dosage of radiation to the tumour while minimizing the dose delivered to nearby healthy tissue.
Fiducial markers may move away from where they were originally implanted. There must be sufficient time between the implantation of markers and treatment in order for the markers to stabilize.
Any procedure that penetrates the body carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.
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