Related Experiment Video
Updated: Jun 15, 2026
Dynamic Lung Tumor Tracking for Stereotactic Ablative Body Radiation Therapy
Published on: June 7, 2015
Fiducial placement for stereotactic radiation by using EUS: feasibility when using a marker compatible with a
Tarek Ammar1, Gregory A Coté, Kimberly M Creach
1Division of Gastroenterology, Department of Medicine, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA.
Background:
Stereotactic radiation by using fiducial markers permits higher doses of radiation while reducing the exposure of uninvolved, adjacent structures. EUS has been used to deploy fiducials, although a 19-gauge needle has traditionally been required.
Objective:
To report a new technique and the feasibility of deploying a fiducial compatible with a 22-gauge needle under EUS guidance.
Design:
Single-center, case series.
Setting:
Tertiary care referral center.
Patients:
Thirteen patients with primary or metastatic cancer referred for stereotactic radiation.
Interventions:
EUS-guided placement of a single fiducial marker that is compatible with a 22-gauge EUS-FNA needle.
Main Outcome Measurements:
Technical success and complications.
Results:
Thirteen patients referred for EUS-guided placement of a fiducial marker were identified in the endoscopic database. Targeted lesions measured 27 +/- 13 mm (range 8-50) x 21 +/- 10 mm (range 6-42). All fiducials were successfully deployed, 9 using a transgastric and 4 using a transduodenal approach. There were no EUS-associated complications. Two patients did not proceed to radiation therapy as a result of interval peritoneal metastasis. However, all fiducials were visible on the roentogram. Eleven of 13 patients (85%) required placement of 1 fiducial, whereas 2 patients (15%) required 2 fiducials.
Limitations:
Uncontrolled feasibility study with limited sample size and follow-up.
Conclusion:
EUS-guided placement of a fiducial using a 22-gauge needle is technically feasible and may permit greater access compared with the 19-gauge needle technique.
