PURPOSE: Robotic radiosurgery using the CyberKnife system has been increasingly used for treatment of inoperable patients with mediastinal and hilar tumors. Robotic radiosurgery requires fiducial markers for the tracking process. Gold rod fiducial markers may be placed by flexible bronchoscopy. We used a novel planning software to help plan more accurate positioning of the fiducials.
METHODS: Fiducial planning was performed using the Broncus LungPoint planning system. A high resolution CT scan was performed. Planning software was developed that allows for computer assistance to help plan appropriate locations for fiducial placement. Target plan incorporates virtual spacing to correspond to images taken in the CyberKnife suite at 45 degrees. It also includes constraints to keep adequate distance from mediastinal vessels. Patient underwent flexible bronchoscopy with insertion of gold rod fiducials using a 19/21 gauge TBNA needle in close proximity to the virtual plan.
RESULTS: All fiducials were located on the planning CT scan prior to treatment. Fiducials were able to be tracked and patient was able to complete planned treatment without complication.
CONCLUSIONS: Stereotactic radiosurgery has been increasingly used for centrally located thoracic malignancies. The accuracy of tracking the tumor with the CyberKnife robotic system relies on successful placement and tracking of fiducials. The markers can be placed by flexible bronchoscopy. To improve accuracy of positioning of fiducials, software has been created to help physician with planning. This software allows for proper spacing of fiducials, avoidance of great vessels and was mindful of the 45 degree angle views present during the CyberKnife treatment. Ideal gold rod fiducial locations may be more accurately planned using this fiducial software.
CLINICAL IMPLICATIONS: Planning software may be helpful in more accurately placing fiducials in preparation for radiosurgery.
DISCLOSURE: Eric Anderson: Consultant fee, speaker bureau, advisory committee, etc.: Consutant for Broncus
Henky Wibowo: Employee: Broncus
Jason Gibbs: Employee: engineer for broncus
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