Fiducial Marker Placement in Liver Treatment Planning Using eTRAX^™ Needle Tip Tracking

CONSIDERATION FOR USE

An 86 year-old-male with a history of metastatic colon cancer to the liver underwent multiple courses of chemotherapy over a period of three years. His disease was under control except for one metastasis in the dome of the liver. Despite multiple courses of chemotherapy, this hepatic lesion persisted. His oncologist exhausted all possible treatment options of chemotherapy and feared further toxicity, and unlikely benefit from further treatments. At this point, his only other option was treatment with radiation. The patient was referred to a radiation oncologist who then referred him to the radiology department for an ultrasound guided fiducial marker placement in the liver to assist in treatment planning.

EQUIPMENT FOR EXAMINATION

GE Healthcare LOGIQ E9 with Volume Navigation with XDclear
CIVCO eTRAX Needle Tip Tracking System

APPROACH TO EXAMINATION

The procedure was performed under ultrasound guidance utilizing fusion technology (GE Healthcare LOGIQ E9 with Volume Navigation), and the eTRAX Needle Tip Tracking system provided by CIVCO Medical Solutions. The fiducial marker was successfully placed in the dome of the liver close to the lesion (as requested by the radiation oncologist).

Fusion of ultrasound and CT images enhanced an otherwise difficult-to-see lesion. Given the location and lack of continuous real-time visualization access challenges would have persisted.

Confident fiducial marker placement in liver treatment planning using Volume Navigation and eTRAX Needle Tip Tracking technology.

Confident placement of the marker without fusion and the eTRAX guidance system would not have been possible. Due to the close proximity of the lesion to the diaphragm and lung, risk of complications would have been higher if this was attempted using conventional guides. In addition, the lesion was difficult to confidently identify with stand alone ultrasound imaging. The only other option would have been performing this placement under CT guidance. This would have been tricky given the location and lack of continuous real-time needle visualization (even with availability of CT fluoro). The other advantage to the ultrasound guided placement over CT is lack of radiation to the patient and the operator.

A pre-treatment CT scan shows satisfactory placement of the fiducial marker.