Name of the Procedure:

Placement of interstitial device(s) for radiation therapy guidance (e.g., fiducial markers, dosimeter), percutaneous, intra-abdominal, intra-pelvic (except prostate), and/or retroperitoneum, single or multiple.

Summary

In this procedure, small devices such as fiducial markers or dosimeters are placed inside the body to guide and improve the accuracy of radiation therapy. These devices help in precisely targeting tumors located in the abdomen, pelvic area, or retroperitoneum. The placement is done through the skin using minimal invasion techniques.

Purpose

The procedure is designed to increase the precision of radiation therapy for treating cancers in the intra-abdominal, intra-pelvic (excluding the prostate), and retroperitoneum areas. Accurate device placement helps in precisely targeting tumors, minimizing damage to surrounding healthy tissues.

Indications

• Patients requiring radiation therapy for cancers located in the intra-abdominal, intra-pelvic, or retroperitoneal regions.
• Cases where precise localization of a tumor is critical for effective radiation treatment.
• Situations where previous imaging methods are insufficient for accurate targeting.

Preparation

• Patients may be instructed to fast for a certain period before the procedure.
• Medications may need to be adjusted, especially blood thinners.
• Diagnostic imaging such as CT scans or MRIs are often required to plan the exact placement of the devices.

Procedure Description

1. A local anesthetic is administered to numb the area.
2. Using imaging guidance (CT or ultrasound), a needle is inserted through the skin to the targeted area.
3. The interstitial device (fiducial marker or dosimeter) is then placed in the precise location through the needle.
4. The needle is removed, and a small bandage is applied to the puncture site.
5. Post-placement imaging may be performed to confirm the correct location of the device.

Duration

The procedure typically takes about 30 to 60 minutes, depending on the number and location of devices placed.

Setting

This procedure is usually performed in a hospital or an outpatient radiology clinic equipped with imaging technology.

Personnel

• Interventional radiologist or radiation oncologist
• Radiologic technologist
• Nursing staff
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

• Infection at the insertion site
• Bleeding or bruising
• Displacement or malfunction of the device
• Potential injury to nearby structures or organs
• Rare complications may include allergic reactions to the anesthetic or contrast dye.

Benefits

• Improved accuracy in radiation therapy leading to better tumor targeting
• Reduced exposure of healthy tissues to radiation
• Potentially enhanced treatment efficacy and reduced side effects

Recovery

• Patients are usually observed for a short time post-procedure to monitor for immediate complications.
• Normal activities can often be resumed within a day, though strenuous activities may be restricted for a few days.
• Follow-up imaging and appointments are required to monitor device placement and effectiveness during radiation therapy.

Alternatives

• External beam radiation therapy without fiducial markers
• Other imaging-based localization techniques
• Surgical methods for tumor localization
• Each alternative may vary in precision, invasiveness, and associated risks.

Patient Experience

• Patients may feel slight pressure or discomfort during the needle insertion.
• Local anesthetic minimizes pain, though there may be minor post-procedural soreness at the puncture site.
• Pain management typically includes over-the-counter pain relievers.
• Detailed instructions will be provided for care and any activity restrictions post-procedure.