Endoscopic Fiducial Placement

Overview

Endoscopic fiducial placement is a procedure in which radiopaque gold fiducial markers are implanted into or adjacent to a pancreatic tumour under endoscopic ultrasound (EUS) guidance. The fiducials serve as surrogates for the tumour position in real-time X-ray or CBCT image guidance during SBRT delivery, enabling precise tumour tracking and tighter treatment margins.

Used by

  • Endoscopic (EUS-guided) fiducial placement is described as a standard pre-treatment procedure in pancreatic SBRT protocols reviewed across nine prospective trials in locally advanced pancreatic cancer; fiducials enable real-time image-guided tumour tracking during delivery on CyberKnife (Synchrony module) and linac-based platforms. PMID:27826200

Notes

  • Performed under endoscopic ultrasound (EUS) guidance using a 22-gauge needle to deploy gold seed fiducials (typically 0.8 mm × 3 mm or 1.2 mm × 3 mm) into the peritumoral pancreatic parenchyma.
  • Required for CyberKnife Synchrony respiratory tracking; also used for CBCT-based IGRT on linac platforms.
  • Complication rate is low (<5%) in experienced centres; rare risks include pancreatitis and fiducial migration.
  • Fiducial visibility on kV X-ray or CBCT is the basis for real-time tracking adjustments during each SBRT fraction.

Sources

This page was processed by entity-page-writer on 2026-05-15.