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Fiducial markers visibility and artefacts in prostate cancer radiotherapy multi-modality imaging

  • Osman, Sarah O. S.1, 2
  • Russell, Emily1
  • King, Raymond B.2
  • Crowther, Karen2
  • Jain, Suneil1, 2
  • McGrath, Cormac3
  • Hounsell, Alan R.1, 2
  • Prise, Kevin M.1
  • McGarry, Conor K.1, 2
  • 1 Queen’s University Belfast, Belfast, Northern Ireland, BT7 1NN, UK , Belfast (United Kingdom)
  • 2 Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK , Belfast (United Kingdom)
  • 3 Belfast Health and Social Care Trust, Forster Green Hospital, Belfast, UK , Belfast (United Kingdom)
Published Article
Radiation Oncology
Springer (Biomed Central Ltd.)
Publication Date
Dec 26, 2019
DOI: 10.1186/s13014-019-1447-1
Springer Nature


BackgroundIn this study, a novel pelvic phantom was developed and used to assess the visibility and presence of artefacts from different types of commercial fiducial markers (FMs) on multi-modality imaging relevant to prostate cancer.Methods and materialsThe phantom was designed with 3D printed hollow cubes in the centre. These cubes were filled with gel to mimic the prostate gland and two parallel PVC rods were used to mimic bones in the pelvic region. Each cube was filled with gelatine and three unique FMs were positioned with a clinically-relevant spatial distribution. The FMs investigated were; Gold Marker (GM) CIVCO, GM RiverPoint, GM Gold Anchor (GA) line and ball shape, and polymer marker (PM) from CIVCO. The phantom was scanned using several imaging modalities typically used to image prostate cancer patients; MRI, CT, CBCT, planar kV-pair, ExacTrac, 6MV, 2.5MV and integrated EPID imaging. The visibility of the markers and any observed artefacts in the phantom were compared to in-vivo scans of prostate cancer patients with FMs.ResultsAll GMs were visible in volumetric scans, however, they also had the most visible artefacts on CT and CBCT scans, with the magnitude of artefacts increasing with FM size. PM FMs had the least visible artefacts in volumetric scans but they were not visible on portal images and had poor visibility on lateral kV images. The smallest diameter GMs (GA) were the most difficult GMs to identify on lateral kV images.ConclusionThe choice between different FMs is also dependent on the adopted IGRT strategy. PM was found to be superior to investigated gold markers in the most commonly used modalities in the management of prostate cancer; CT, CBCT and MRI imaging.

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