gold marker beads in the skull

[BeJoi]

Hi Everyone,

I'm going to be doing FSR and the radiation oncologist wants to implant gold marker beads in my skull to help make the radiation even more accurate.  I was told this was a simple, outpatient procedure, but it still scares me.

Has anyone else had this procedure, and if you have, would you please tell me what is involved in it

Thank you,

Beverly

[Mark]

Beverly,

what machine is the doctor talking about using? fiducials for a skull based radiation treatment is bizarre to me and I've never heard of it. Typically, the skull itself is used for frame of reference and immobilizing it in some fashion ( usually head frame or mask) is all that is required. Fiducials, which is what the implanted markers are called, is only used by machines like CK to treat tumors below the neck where accounting for body movement in respiration is critical. CK and GK are the most accurate of the radiosurgical machines out there and they don't require gold bead markers. This sounds like someone trying to do something to increase the accuracy of one of the less precise radiotherapy machines.

Mark

[BeJoi]

Hi Mark,

It's the Trilogy System, which has good accuracy, but not as precise as CK or GK.  They do use a mask, but he wanted to enhance the accuracy even more.  I've been doing research, and I have not found any published articles on implanting these markers in the skull.  I'm worried about the whole procedure; but the radiation oncologist, who trained under Ian Crocker at Emory here in Atlanta on the Trilogy System, seems very sure that implanting these are a good idea.

Beverly

[ppearl214]

Beverly, I (personally) have only heard of markers being used with radio"therapy" (ie: for breast cancer and such) and haven't heard of it used for radio-surgery.  Now, granted, I am not all that versed on the Trilogy system, I'd love to hear more about this.......  Have you spoken to Dr. Crocker to get his take on using markers for the treatment?

Phyl

[krbonner]

I won't pretend that I'm at all knowledgable about this, but it's my understanding that at least one of the radiation protocols used for ANs at Mass General Hospital uses tiny maker "beads" inserted just under the skin at several places around the skull.  The idea is that the machines use the beads for calculations and it doesn't require the headframe or mask.  My neighbor is a radiation physicist at MGH and has worked with many AN patients and was describing the process to me back when I was first diagnosed.

Wish I knew more for you!   

Katie

[BeJoi]

Thanks for all of your comments.  I spoke to the radiation oncologist today.  They would actually be implanting them in my skull, and their use is solely for the purpose of helping the Trilogy System align properly for each treatment.  They are not necessary, nor do they add to the accuracy of the treatment.  I've chosen not to have them implanted, and it simply means that I will spend 5 to 10 minutes longer on the table every day of the treatment while the technician aligns whatever it is they need to align for each treatment.  I will be using the plastic mask instead of a head frame, since I'm doing 28 sessions of FSR.

I feel very relieved      not to have an outpatient procedure to implant anything in my skull.  I'm doing radiation to hopefully not have to do anything invasive.  Of course, the outcome of the treatment is still be determined.

I'll be having the mask made this Friday.  And then I will take another MRI very soon.  The treatment is scheduled to begin June 18.  I'll keep you all posted.

Beverly

[Craig]

It sounds like your doc was being overly cautious. Here is what happens when you go in for the Trilogy treatment. When they lie you on the table, they will put your mask on and clamp you down. They will then put a box over your head and the doctors will configure the machine to your position on the table. While they are doing this, you will hear the machine move around you and the table that you lie on will move as well. It is a little wierd at first because you are thinking that they are deciding where to have the radiation hit the AN. The good thing about the Trilogy system is that you will be in and out of the doctors office within an hour or so or at least I was. The treatments only take 20-25 minutes and you are done for the day. I know you will do fine.

Cheers,

Craig

[BeJoi]

Thanks, Craig.  I never know what is motivating a doctor to do something, but I'm in a "questioning everything" mode.  The gold marker beads seem trivial enough in soft tissue, but sticking them in my skull didn't sound too pleasant or overly necessary.  I can see his point, though.  I think the beads allow the Trilogy machine to align itself, and without the beads, a technician has to do the alignment.  It just means I'm clamped in the mask a little longer.  I'm sure by the 28th time, it will seem like a piece of cake.

How are you feeling?  Are the side effects still minimal?

Beverly

[ppearl214]

Hi Beverly and Craig,

Please keep us updated on how the treatment goes and post-treatment. I am following this closely as, for me, this is new info on radio-treatment that I was not aware and want to follow your progress.  Beverly, I have a feeling you are going to do great!  Craig, continued wellness to you.

Phyl

[BeJoi]

Thanks, Phyl.  I'll keep you posted.

[Craig]

Beverly,

I am doing fine. I am no longer fatigued during the day. The tinnitus has decreased to where I don't even notice it most of the time. It was louder before radiation treatments. The only problem now is that I sometimes wake up in the middle of the night and can't go back to sleep. I put myself on the over the counter Melatonin which is a natural sleep aid. I have been on it a week and I slept great last night.

Good luck on your treatments,

Cheers,

Craig