CardioVascular and Interventional Radiology

, Volume 38, Issue 5, pp 1288–1293 | Cite as

Transarterial Fiducial Marker Placement for Image-guided Proton Therapy for Malignant Liver Tumors

  • Kengo Ohta
  • Masashi Shimohira
  • Shigeru Sasaki
  • Hiromitsu Iwata
  • Hiroko Nishikawa
  • Hiroyuki Ogino
  • Masaki Hara
  • Takuya Hashizume
  • Yuta Shibamoto
Technical Note



The aim of this study is to analyze the technical and clinical success rates and safety of transarterial fiducial marker placement for image-guided proton therapy for malignant liver tumors.

Methods and Materials

Fifty-five patients underwent this procedure as an interventional treatment. Five patients had 2 tumors, and 4 tumors required 2 markers each, so the total number of procedures was 64. The 60 tumors consisted of 46 hepatocellular carcinomas and 14 liver metastases. Five-mm-long straight microcoils of 0.018 inches in diameter were used as fiducial markers and placed in appropriate positions for each tumor. We assessed the technical and clinical success rates of transarterial fiducial marker placement, as well as the complications associated with it. Technical success was defined as the successful delivery and placement of the fiducial coil, and clinical success was defined as the completion of proton therapy.


All 64 fiducial coils were successfully installed, so the technical success rate was 100 % (64/64). Fifty-four patients underwent proton therapy without coil migration. In one patient, proton therapy was not performed because of obstructive jaundice due to bile duct invasion by hepatocellular carcinoma. Thus, the clinical success rate was 98 % (54/55). Slight bleeding was observed in one case, but it was stopped immediately and then observed. None of the patients developed hepatic infarctions due to fiducial marker migration.


Transarterial fiducial marker placement appears to be a useful and safe procedure for proton therapy for malignant liver tumors.


Fiducial marker Transarterial Proton therapy 



This research was not supported by any foundations.

Conflict of Interest

Kengo Ohta, Masashi Shimohira, Shigeru Sasaki, Hiromitsu Iwata, Hiroko Nishikawa, Hiroyuki Ogino, Masaki Hara, Takuya Hashizume, and Yuta Shibamoto have no conflicts of interest.


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Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2014

Authors and Affiliations

  • Kengo Ohta
    • 1
  • Masashi Shimohira
    • 1
  • Shigeru Sasaki
    • 2
  • Hiromitsu Iwata
    • 2
  • Hiroko Nishikawa
    • 2
  • Hiroyuki Ogino
    • 2
  • Masaki Hara
    • 2
  • Takuya Hashizume
    • 1
  • Yuta Shibamoto
    • 1
  1. 1.Department of RadiologyNagoya City University Graduate School of Medical SciencesNagoyaJapan
  2. 2.Department of Radiation Oncology, Nagoya Proton Therapy CenterNagoya City West Medical CenterNagoyaJapan

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