Radiation therapy (RT) is used in operable and inoperable esophageal cancer patients. Endoscopic ultrasound-guided fiducial marker placement allows improved translation of the disease extent on endoscopy to computed tomography (CT) images used for RT planning and enables image-guided RT. However, microscopic tumor extent at the time of RT planning is unknown. Endoscopic optical coherence tomography (OCT) is a high-resolution (10-30µm) imaging modality with the potential for accurately determining the longitudinal disease extent. Visibility of fiducial markers on OCT is crucial for integrating OCT findings with the RT planning CT.
We investigated the visibility on OCT (NinePoint Medical, Inc.) of 13 commercially available solid (Visicoil, Gold Anchor, Flexicoil, Polymark, and QLRAD) and liquid (BioXmark, Lipiodol, and Hydrogel) fiducial markers of different diameter. We designed and manufactured a set of dedicated Silicone-based esophageal phantoms to perform imaging in a controlled environment. The esophageal phantoms consist of several layers with different TiO2 concentrations to simulate the scattering properties of a typical healthy human esophagus. Markers were placed at various depths (0.5, 1.1, 2.0, and 3.0mm).
OCT imaging allowed detection of all fiducial markers and phantom layers. The signal to background ratio was 6-fold higher for the solid fiducial markers than the liquid fiducial markers, yet OCT was capable of visualizing all 13 fiducial markers at all investigated depths. We conclude that RT fiducial markers can be visualized with OCT. This allows integration of OCT findings with CT for image-guided RT.
Pouya Jelvehgaran, Tanja Alderliesten, Jelmer J. A. Weda, Daniel M. de Bruin, Dirk J. Faber, Maarten C.C. M. Hulshof, Ton G. van Leeuwen, Marcel B. van Herk, and Johannes F. de Boer, "Visibility of solid and liquid fiducial markers used for image-guided radiation therapy on optical coherence tomography: an esophageal phantom study (Conference Presentation)," Proc. SPIE 10056, Design and Quality for Biomedical Technologies X, 100560B (Presented at SPIE BiOS: January 28, 2017; Published: 20 April 2017); https://doi.org/10.1117/12.2250911.5371820533001.
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