Implanting metal fiducials to guide stereotactic liver radiation: McGill experience and review of current devices, techniques and complications.

In this work we report our technique and outcomes placing percutaneous liver fiducials, summarize the literature on the risks of this procedure and present the various fiducials available today. Thirty-nine subjects, 27 males and 12 females who had received liver fiducial implants between November 2006 and September 2010 were retrospectively studied. Eighty-five gold cylinders (15%) and platinum coils (85%) were inserted under computed tomography (CT) guidance. All fiducials placed proved adequate to proceed with radiation image guidance. With one notable exception of gross migration, fiducials were inserted without serious complications. Although fiducial implantation in the liver has proven successful, the procedure does carry a variety of risks.