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Clinical Publications

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“[OA126] Intrafractional imaging during volumetric modulated arc therapy (VMAT) prostate treatment in combination with gold anchor fiducials”

Purpose: Triggered imaging is the use of kV image acquisition during treatment delivery to monitor intrafractional motion of implanted fiducials. An automatically identified fiducial point on the kV image is compared to its expected position predetermined from the treatment planning CT, and the treatment can be paused if the difference exceeds a user-definable tolerance.

Conclusion: Triggered imaging seems to perform satisfactorily when used in combination with well-separated and compressed Gold Anchor fiducials.

Article from Sahlgrenska University Hospital, Gothenburg, Sweden 2018

“MRI visibility of gold fiducial markers for image-guided radiotherapy of rectal cancer”

Abstract: Background and purpose: A GTV boost is suggested to result in higher complete response rates in rectal cancer patients, which is attractive for organ preservation. Fiducials may offer GTV position verification on (CB)CT, if the fiducial-GTV spatial relationship can be accurately defined on MRI. The study aim was to evaluate the MRI visibility of fiducials inserted in the rectum.

Conclusion: The Visicoil 0.75 and Gold Anchor fiducials were the most visible fiducials on MRI as they were most consistently identified. The use of a registered (CB)CT and a T1 3D GRE MRI sequence is recommended.

Article from The Green Journal, 2018

“Low Infection Rate After Transrectal Implantation of Gold Anchor ™ Fiducial Markers in Prostate Cancer Patients After Non-broad-spectrum Antibiotic Prophylaxis”

Abstract: In 621 consecutive prostate cancer patients, the frequency of urinary tract infections (UTI) and marker loss was evaluated. They prophylactically received a single dose of non-broad-spectrum antibiotics and transrectal implantation of three thin needle fiducial markers, Gold Anchor ™ (GA). The occurrence of UTIs, sepsis, hospitalization due to infection, and marker loss after implantation was assessed from the medical records containing notes from physicians and nurses from the day of implantation to the end of 29 fractions. UTIs occurred in two (0.3%) of the 621 patients. Neither sepsis nor hospitalization was noted. Loss/drop-out of three markers was noted among 1,863 markers implanted.

Conclusion: The use of thin needles for the implantation of fiducials appears to reduce the rate of infection despite the use of a single dose of non-broad-spectrum antibiotics as prophylaxis. The marker construct appears to provide stability in the tissues.

Article from Karolinska University Hospital, 2018

“Usefulness of Iron-Containing Fiducial Marker for Prostate Radiotherapy”

Abstract: Visualization of markers is critical for imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI). However, the size of the marker varies according to the imaging technique. While a large-sized marker is more useful for visualization in MRI, it results in artifacts on CT and causes substantial pain on administration. In contrast, a small-sized marker reduces the artifacts on CT but hampers MRI detection. Herein, we report a new iron-containing marker and compare its utility with that of non-iron-containing markers…

Conclusion: Our findings show that an iron-containing marker is extremely useful in image registration. Bleeding and pain can be avoided by using a thin needle, and the marker can be recognized on prostatic MRI even when using a thin 22 G needle. The present findings suggest that the Gold Anchor will indeed be useful in daily practice.

Article in Polish Journal of Medical Physics and Engineering, 2016

“Assessment of the feasibility and complications of implanting “Gold Anchor 25 G” fiducial markers by transparietal puncture under scanner before Cyberknife radiotherapy of lung nodules”

Summary: This is the largest series reporting the feasibility and complications of the use of the Gold Anchor 25G system for percutaneous puncture in the lung. This is a quick procedure, performed under local anesthesia. A single marker per lesion minimizes the risk of complications related to the implementation: with a pneumothorax rate of 25% versus 40-82% according to the series for 17 to 19G needles a rate of only 1.5% hemoptysis for the Gold Anchor 25G system.

Poster at SFRO 2015

“Visibility and artifacts of gold fiducial markers used for IGRT of pancreatic cancer on MRI”

Summary: The authors selected ten different markers suitable for endoscopic placement in the pancreas and tested the visibility and artifacts of these markers on magnetic resonance imaging (MRI). They conclude that when visibility of the markers is most important, markers that contain iron [Gold Anchor] are optimal, preferably in a folded configuration.

Article in Medical Physics, May 2014

“Establishing adequately visible endoscopically implantable gold markers for CT, cone-beam CT and MRI”

Summary: Users interested in seeing the markers for CT-MRI registration purposes should use 0.28×10 mm Gold Anchor markers.

Poster at ESTRO 2014

“CyberKnife Markers Visible on CT and MRI”

Conclusion: We describe the use of the Gold Anchor fiducial markers in this poster. They have the advantage that a small amount of ferromagnetic material is mixed in the gold alloy to allow better visibility on MRI imaging than gold alloy fiducials alone. There are other markers that have been described (ref. 1) that also have a good signal on MRI imaging. One of the additional advantages of the Gold Anchor markers, however, is their crumpling effect that keeps them in position in soft tissue and low density lung tissues.

Poster at The SRS/SBRT Scientific Meeting 2014

“Investigation of dosimetric effects of radiopaque fiducial markers for use in proton beam therapy with film measurements and Monte Carlo simulations”

Summary: The purpose was to estimate the dose perturbation introduced by implanted radiopaque fiducial markers in proton beam therapy (PBT) and to compare cylindrical 1.2 x 3.0 mm and 0.6 x 4.0 mm gold markers to 0.28×20 mm Gold Anchor markers. Radiochromic film measurements of a phantom showed that the Gold Anchor marker causes the least dose perturbations in proton beams. It is concluded that the major advantages of the Gold Anchor marker makes it superior and may be used in future PBT.

Thesis report, Stockholm University, April 2014

“Spatial Accuracy and Visibility Studies of a MRI Compatible Gold Anchor™ Fine Needle Fiducial Marker”

Conclusion: The new MRI compatible Gold Anchor™ adds new features on top of the existing advantages. For specific anatomical targets treatment planning with fiducial marker information can be performed based only on MR images. For other targets images from both MRI and CT can be matched through the information from the fiducials. The content of iron may be changed to optimize the best signal to disturbance ratio.

Poster at ASTRO 2012

“Assessment of stability of Gold Anchor™ fiducial marker implants in the prostate”

Conclusion: The position of the Gold Anchor™ fiducial marker in the prostate gland is stable, the marker remaining within the gland volume. The period of marker stabilization is less than the 7 days recommended by the manufacturer. We suggest that virtual simulation of the patient can be performed immediately after marker implantation.

E-Poster (E31-0276) at ESTRO 2012

“Comparison of the SBRT frame procedure versus Gold Anchor fiducial marker IGRT on Accuracy, Precision and Economy”

Conclusion: Positioning of the target with orthogonal images or CBCT with the Gold Anchor fiducial marker insertion is intuitive and easily accomplished for safe positioning. Excellent accuracy and precision can be achieved without the need of positioning patients in stereotactic whole body frames. The total cost of treatments with the Gold Anchor technique is less than with the use of the stereotactic coordinate set up due to less time needed in the treatment room and for preparations. However a fixation system may be essential to minimize body movements during treatment.

Poster at ASTRO 2011, Poster #3367

“Using Foldable Gold Anchor Markers for Fiducial Tracking with the CyberKnife”

Conclusion: It is feasible to use gold anchor marker for Cyberknife. Ball shape or Tadpole gold anchor markers are recommended. Visual confirmation of lock-on is important due to the irregular shape of gold anchor markers. More study is needed to evaluate clinical effect.

Presentation at the 2011 CyberKnife® Robotic Radiosurgery Summit

“An assessment of inter and intrafraction prostate mobility using Gold Anchors during prostate cancer patients volumetric modulated arc radiotherapy (RapidArc)”

Conclusion: The patient positioning using 2D/2D kV and Gold Anchors increases the setup precision and enables to reduce margins. Because the prostate motion during the course of radiotherapy can be significant, margins for the PTV should include the intrafraction prostate mobility.

Poster at ESTRO 2010, poster #1674

“Gold Anchor™ marker for IGRT, a new fiducial for high-precision radiotherapy”

Conclusion: Increasingly, we must be certain of exact localization of tumor targets by using markers and IGRT. The fine-needle marker presented here allows implantation into almost any tumor site with minimal risks of internal bleeding, infection or pneumothorax and can be implanted safely and precisely using guidance with ultrasound or CT. The Gold Anchor™ is developed for visualization with kilo voltage equipment during radiotherapy.

Poster at ASTRO 2009

“XVI Gold Anchor Seed Project”

Conclusion: The gold seed markers can be seen clearly using the clinical 3DCBCT and 4DCBCT protocol which means the seeds can be used clinically to track the tumour position using XVI at the point of treatment delivery.

S:t James’s Hospital, Leeds, UK, 2011

“An evaluation of side effects after gold markers (Gold Anchor™) implantation to prostate gland in patients with prostate cancer”

Conclusion: The Gold Anchors implantation is small invasive and safe method. The risk of side effects appearance is low.

English, translation from Polish article
Polish original

“Stereotactic radiotherapy of malignant tumors of the liver with golden markers application”

English, translation from Polish article
Polish original

“Zastosowanie złotych znaczników w radioterapii kierowanej obrazem u chorych na raka gruczołu krokowego”

Article in Polish, Onkologia-inf-4-2009