Markers/No markers

User

Posted 20 Oct 2022 at 16:23

I have recently started down the route of HT/RT, having started HT about 4 months ago. Today I went for my first RT appointment expecting to have fiducial markers inserted. However, this was not possible due to a slight urine infection (the second time this has occurred).The nurse said that they could continue without the need for markers, by using a CT scan each time I attend for RT treatment and that this would have no effect on the accuracy or effectiveness of the treatment. I am due for my CT scanning planning session next week.

I would appreciate any views on this, especially from those who have had RT treatment without fiducial markers, as I believe not all hospitals use them .

User

Posted 20 Oct 2022 at 16:37

I think more men here have had RT with tattoos than with gold seeds / markers. As you have been advised, it should make no difference to you at all, it just takes the RT team a little longer to line you up correctly.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 20 Oct 2022 at 16:43

I just had the tattoos, not the markers. I imagine that it’ll just slightly increase the time it takes to accurately align you on the machine’s treatment table. Did they say why they couldn’t do tattoos?

Best wishes,

Chris

Edited by member 20 Oct 2022 at 16:44 | Reason: Not specified

User

Posted 20 Oct 2022 at 17:06

Thanks Chris.

They may well do tattoos at my next appointment. It was just that they didn’t wish to use markers due to the risk of increased infection, although they didn’t seem concerned enough to give me antibiotics.

User

Posted 20 Oct 2022 at 17:25

I didn't have fiducial markers because I was having HDR brachy too, and they get in the way.

Instead of doing a pair of X-rays before each treatment as they would with the fiducial markers, they do a Cone Beam CT scan before each session instead. This adds about 5 mins to each session for the scan time and processing the images into a 3-d model the radiographers use to position you.

You should get the tattoos either way - they are used for the initial course alignment each time.

Edited by member 20 Oct 2022 at 17:27 | Reason: Not specified

User

Posted 20 Oct 2022 at 19:06

Nobody even mentioned markers when I had my RT. It seems that not all hospitals use them.

Chris

User

Posted 20 Oct 2022 at 20:34

I had the tats and the gold seed markers. The insertion of the markers was quick and painless. When it came to the RT sessions, initial lining up was done physically by nurses with laser beam alignment using the tats but that was followed by a CT scan which used the markers, followed by some thinking from the radiographers and the massive computer behind this process, leading to automated micro adjustment of the bed I was lying on. I guess it's possible to achieve good alignment without the tats but the more precise they can be, the better.

Jules

Edited by member 20 Oct 2022 at 20:59 | Reason: Not specified

User

Posted 20 Oct 2022 at 21:37

Yes I just had the tatoos, assumed that was the way it was done, no mention of any other method, Lay on bed, various small adjustments made by 'machine', lined up with tattoos. Scans made now and then, cannot remember how often. Had the 37 sessions.

Peter

User

Posted 20 Oct 2022 at 21:45

Still, I am glad that nothing happened to delay any of my treatment sessions. By the end of my RT it was a bit "touch and go" as to whether or not I could hold in the obligatory three cups of water until the end of the process. No "mishaps" fortunately, but I'm glad the process wasn't five minutes longer!

Chris

User

Posted 21 Oct 2022 at 12:30

RT at Royal Surrey, had gold seeds and tattoos. No problem with seed insertion, better than the biopsy! Lined up on the bed by pretty radiographers although being on zoladex rather spoilled the occasion. New super RT machine keeps the beam accurate. All over in 10 mins. The worst problem is drinking sufficient water to fill the bladder and hoping there is no delay for your session! It's been a close call occasionally. Some radiation side effects but tolerable.

User

Posted 21 Oct 2022 at 20:21

Fiducial markers (or cone beam CT scans) haven't always been used. They only became necessary as the LINAC aiming and beam shaping became more accurate than lining up using the tattoos alone could achieve. When they were first used, typical protocols were to use them for perhaps the first 5 sessions, and then only weekly thereafter, and for the sessions they weren't used, aligning was done same as the session before but just using the tattoos. Around 2018, most places were switching to doing accurate aligning every session. The accurate alignment may have been more important for hypofractionation (and certainly is for ultrafractionation/SABR).

User

Posted 21 Oct 2022 at 21:55

When I had my RT back in 2008, the study critera was to preface the IMRT part with a CT scan either once a week or once a fortnight, I can't readily remember without going throuh my papers. In the event, the interval between these scans was longer and I did question this. I was told that they didn't want to add to the radiation of which I was having plenty. In fact I had 5 CT scans as part of the preliminary setting up procedure in one week.

Barry

User

Posted 21 Oct 2022 at 23:18

Originally Posted by: Online Community Member

Interesting, I had a CT scan for each and every one of my 45 fractions. In fact, I think I had a couple of extra ones when it was discovered that my bladder wasn't full enough and the re-ran the whole process.

Jules

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