Abstract
Purpose: When treating lung lesions using CyberKnife (Accuray Inc, Sunnyvale, CA), a common tool for patient alignment and target localization is the use of radio‐opaque fiducial markers in conjunction with stereoscopic kV imaging. This requires that there not be any variation in marker location throughout a treatment regimen. The high occurrence of fiducial marker migration (especially in lungs) has yielded the development of markers specifically designed to reduce migration. One such marker is the Gold Anchor (Radiadyne LLC, Houston, TX). This study evaluates the capability of the CyberKnife Radiostereoscopic Target Locating System (TLS) to track these implants. This is the only such investigation of these seeds used in the described capacity. Methods and materials: This study evaluates the GA200‐20 Gold Anchor, a 2.0 mm‐long marker that is designed to be injected through a needle, and upon contact with tissue, will collapse into an irregular shape. This irregular shape prevents the marker from migrating. Three markers are placed in an XLT Lung Phantom (CIRS Inc, Norfolk, VA); three being required by the TLS to correct for translational and rotational target motion. The phantom was then imaged using CT, and a treatment plan was designed. Following fiducial localization and subsequent table corrections, 500 cGy was homogeneously delivered to a small spherical target within the phantom, where orthogonal radiochromic film was placed. Results: Using clinically‐relevant imaging parameters, the Gold Anchor was accurately tracked by the TLS. On average, we were able to deliver the prescribed dose to the target volume with less than 0.5 mm targeting deviation, with 0.7mm being the highest deviation. Conclusions: This study shows that these markers are able to be tracked by the CyberKnife's TLS. This is a required initial step for future clinical studies where these markers are used to aid in the target tracking of lung lesions.
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