Fiducial markers: can the urologist do better?

Catriona Duncan, Daryl Lim Joon, Nathan Lawrentschuk, Trish Jenkins, Michal Schneider, Vincent Khoo, Michael Chao, Marita Lawlor, Rachel O’Meara, Colleen Berry, Angela Viotto, Kerryn Brown, Morikatsu Wada, Farshad Foroudi, Shomik Sengupta

Research output: Contribution to journalArticleResearchpeer-review

1 Citation (Scopus)

Abstract

Introduction: Radiotherapy to the bladder has a risk of toxicity to pelvic structures, which can be reduced by using fiducial markers for targeting. Injectable contrast offers an alternative marker to gold seeds, which may fall out or exacerbate scarring. Combining contrast agents with tissue glue can minimize dispersion through tissue, enhancing its utility. We evaluated combinations of contrast agents and tissue glue using porcine bladder, for feasibility and utility as fiducial markers to aid image-guided radiotherapy. Methods: Different contrast agents (Lipiodol ultra or Urografin) were combined with different tissue glues (Histoacryl, Tisseal or Glubran2). The mixtures were endoscopically injected into porcine bladder submucosa to identify the area of interest with multiple fiducial markers. The porcine bladders were imaged within a phantom porcine pelvis using standard radiation therapy imaging modalities. The feasibility as an injectable fiducial marker and visibility of each fiducial marker on imaging were scored as binary outcomes by two proceduralists and two radiation therapists, respectively. Results: Lipiodol–glue combinations were successfully administered as multiple fiducials that were evident on CT and CBCT. Lipiodol with Histoacryl or Glubran2 was visible on kV imaging. The Lipiodol Glubran2 combination was deemed subjectively easiest to use at delivery, and a better fiducial on KV imaging. Conclusion: This study demonstrates the feasibility of mixing contrast medium Lipiodol with Histoacryl or Glubran2 tissue glue, which, injected endoscopically, provides discrete and visible fiducial markers to aid image-guided radiotherapy. Although promising, further study is required to assess the durability of these markers through a course of radiotherapy.

Original languageEnglish
Pages (from-to)1281–1287
Number of pages7
JournalWorld Journal of Urology
Volume37
Issue number7
DOIs
Publication statusPublished - Jul 2019

Keywords

  • Bladder cancer
  • Cone beam computed tomography
  • Endoscopy
  • Fiducial markers
  • Image-guided radiotherapy
  • Iodized oil
  • Prostate cancer
  • Tissue glue

Cite this

Duncan, Catriona ; Joon, Daryl Lim ; Lawrentschuk, Nathan ; Jenkins, Trish ; Schneider, Michal ; Khoo, Vincent ; Chao, Michael ; Lawlor, Marita ; O’Meara, Rachel ; Berry, Colleen ; Viotto, Angela ; Brown, Kerryn ; Wada, Morikatsu ; Foroudi, Farshad ; Sengupta, Shomik. / Fiducial markers : can the urologist do better?. In: World Journal of Urology. 2019 ; Vol. 37, No. 7. pp. 1281–1287.
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title = "Fiducial markers: can the urologist do better?",
abstract = "Introduction: Radiotherapy to the bladder has a risk of toxicity to pelvic structures, which can be reduced by using fiducial markers for targeting. Injectable contrast offers an alternative marker to gold seeds, which may fall out or exacerbate scarring. Combining contrast agents with tissue glue can minimize dispersion through tissue, enhancing its utility. We evaluated combinations of contrast agents and tissue glue using porcine bladder, for feasibility and utility as fiducial markers to aid image-guided radiotherapy. Methods: Different contrast agents (Lipiodol ultra or Urografin) were combined with different tissue glues (Histoacryl, Tisseal or Glubran2). The mixtures were endoscopically injected into porcine bladder submucosa to identify the area of interest with multiple fiducial markers. The porcine bladders were imaged within a phantom porcine pelvis using standard radiation therapy imaging modalities. The feasibility as an injectable fiducial marker and visibility of each fiducial marker on imaging were scored as binary outcomes by two proceduralists and two radiation therapists, respectively. Results: Lipiodol–glue combinations were successfully administered as multiple fiducials that were evident on CT and CBCT. Lipiodol with Histoacryl or Glubran2 was visible on kV imaging. The Lipiodol Glubran2 combination was deemed subjectively easiest to use at delivery, and a better fiducial on KV imaging. Conclusion: This study demonstrates the feasibility of mixing contrast medium Lipiodol with Histoacryl or Glubran2 tissue glue, which, injected endoscopically, provides discrete and visible fiducial markers to aid image-guided radiotherapy. Although promising, further study is required to assess the durability of these markers through a course of radiotherapy.",
keywords = "Bladder cancer, Cone beam computed tomography, Endoscopy, Fiducial markers, Image-guided radiotherapy, Iodized oil, Prostate cancer, Tissue glue",
author = "Catriona Duncan and Joon, {Daryl Lim} and Nathan Lawrentschuk and Trish Jenkins and Michal Schneider and Vincent Khoo and Michael Chao and Marita Lawlor and Rachel O’Meara and Colleen Berry and Angela Viotto and Kerryn Brown and Morikatsu Wada and Farshad Foroudi and Shomik Sengupta",
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Duncan, C, Joon, DL, Lawrentschuk, N, Jenkins, T, Schneider, M, Khoo, V, Chao, M, Lawlor, M, O’Meara, R, Berry, C, Viotto, A, Brown, K, Wada, M, Foroudi, F & Sengupta, S 2019, 'Fiducial markers: can the urologist do better?', World Journal of Urology, vol. 37, no. 7, pp. 1281–1287. https://doi.org/10.1007/s00345-018-2515-0

Fiducial markers : can the urologist do better? / Duncan, Catriona; Joon, Daryl Lim; Lawrentschuk, Nathan; Jenkins, Trish; Schneider, Michal; Khoo, Vincent; Chao, Michael; Lawlor, Marita; O’Meara, Rachel; Berry, Colleen; Viotto, Angela; Brown, Kerryn; Wada, Morikatsu; Foroudi, Farshad; Sengupta, Shomik.

In: World Journal of Urology, Vol. 37, No. 7, 07.2019, p. 1281–1287.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Fiducial markers

T2 - can the urologist do better?

AU - Duncan, Catriona

AU - Joon, Daryl Lim

AU - Lawrentschuk, Nathan

AU - Jenkins, Trish

AU - Schneider, Michal

AU - Khoo, Vincent

AU - Chao, Michael

AU - Lawlor, Marita

AU - O’Meara, Rachel

AU - Berry, Colleen

AU - Viotto, Angela

AU - Brown, Kerryn

AU - Wada, Morikatsu

AU - Foroudi, Farshad

AU - Sengupta, Shomik

PY - 2019/7

Y1 - 2019/7

N2 - Introduction: Radiotherapy to the bladder has a risk of toxicity to pelvic structures, which can be reduced by using fiducial markers for targeting. Injectable contrast offers an alternative marker to gold seeds, which may fall out or exacerbate scarring. Combining contrast agents with tissue glue can minimize dispersion through tissue, enhancing its utility. We evaluated combinations of contrast agents and tissue glue using porcine bladder, for feasibility and utility as fiducial markers to aid image-guided radiotherapy. Methods: Different contrast agents (Lipiodol ultra or Urografin) were combined with different tissue glues (Histoacryl, Tisseal or Glubran2). The mixtures were endoscopically injected into porcine bladder submucosa to identify the area of interest with multiple fiducial markers. The porcine bladders were imaged within a phantom porcine pelvis using standard radiation therapy imaging modalities. The feasibility as an injectable fiducial marker and visibility of each fiducial marker on imaging were scored as binary outcomes by two proceduralists and two radiation therapists, respectively. Results: Lipiodol–glue combinations were successfully administered as multiple fiducials that were evident on CT and CBCT. Lipiodol with Histoacryl or Glubran2 was visible on kV imaging. The Lipiodol Glubran2 combination was deemed subjectively easiest to use at delivery, and a better fiducial on KV imaging. Conclusion: This study demonstrates the feasibility of mixing contrast medium Lipiodol with Histoacryl or Glubran2 tissue glue, which, injected endoscopically, provides discrete and visible fiducial markers to aid image-guided radiotherapy. Although promising, further study is required to assess the durability of these markers through a course of radiotherapy.

AB - Introduction: Radiotherapy to the bladder has a risk of toxicity to pelvic structures, which can be reduced by using fiducial markers for targeting. Injectable contrast offers an alternative marker to gold seeds, which may fall out or exacerbate scarring. Combining contrast agents with tissue glue can minimize dispersion through tissue, enhancing its utility. We evaluated combinations of contrast agents and tissue glue using porcine bladder, for feasibility and utility as fiducial markers to aid image-guided radiotherapy. Methods: Different contrast agents (Lipiodol ultra or Urografin) were combined with different tissue glues (Histoacryl, Tisseal or Glubran2). The mixtures were endoscopically injected into porcine bladder submucosa to identify the area of interest with multiple fiducial markers. The porcine bladders were imaged within a phantom porcine pelvis using standard radiation therapy imaging modalities. The feasibility as an injectable fiducial marker and visibility of each fiducial marker on imaging were scored as binary outcomes by two proceduralists and two radiation therapists, respectively. Results: Lipiodol–glue combinations were successfully administered as multiple fiducials that were evident on CT and CBCT. Lipiodol with Histoacryl or Glubran2 was visible on kV imaging. The Lipiodol Glubran2 combination was deemed subjectively easiest to use at delivery, and a better fiducial on KV imaging. Conclusion: This study demonstrates the feasibility of mixing contrast medium Lipiodol with Histoacryl or Glubran2 tissue glue, which, injected endoscopically, provides discrete and visible fiducial markers to aid image-guided radiotherapy. Although promising, further study is required to assess the durability of these markers through a course of radiotherapy.

KW - Bladder cancer

KW - Cone beam computed tomography

KW - Endoscopy

KW - Fiducial markers

KW - Image-guided radiotherapy

KW - Iodized oil

KW - Prostate cancer

KW - Tissue glue

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U2 - 10.1007/s00345-018-2515-0

DO - 10.1007/s00345-018-2515-0

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