Use of a blood patch technique to prevent pneumothorax during insertion of Lung fiducials

Abstract

The use of the CyberKnife® (Accuray Incorporated, Sunnyvale, CA) for radiosurgical treatment of lung tumors [1] typically requires placement of one or more gold fiducials for tracking during treatment. Possible exceptions to this requirement are tumors involving the posterior chest wall, which may be localized with Xsight™ (Accuray Incorporated, Sunnyvale, CA) based on spinal anatomy. Placement of gold fiducial seeds has been associated with post-placement pneumothorax at rates of 25-40% [1]. Some of these patients will require treatment by chest tube placement, and all of them will require repeated physician exams and radiological follow-up. In addition, some patients are refused consideration for radiosurgery for fear they will be unable to tolerate a potential pneumothorax. Pneumothorax prevention, therefore, has become a major priority in CyberKnife radiosurgery for lung cancer. © 2007 Springer-Verlag Berlin Heidelberg.