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The purpose is to describe the method, safety and efficacy of transperineal gold seed placement for image‐guided radiation therapy.    Methods  An ethics committee approved database was used to review records of consecutive patients from October 2008 through December 2013, who underwent transperineal implantation of three gold markers into the prostate using staged local anaesthesia and transrectal ultrasound. Seeds were counted on radiographs from  CT  simulation, first treatment and last treatment. Retention and use of at least three markers for  kV / kV  matching was considered a successful implant. A visual analogue scale ( VAS ) pain assessment was performed.  SAS  was used for data analysis.    Results  Fiducial marker placement was successful for  kV / kV  matching in 556/581 patients (95.7%). The procedure was aborted due to pain in two patients. Additional sedation during the procedure was required in two patients. Complications include urinary infections (2 patients, <0.5%) and transient haematuria (2 patients, <0.5%). There were no recorded calls requesting additional pain medication or delays in radiation due to complications. The number of seeds identified at simulation: 4 (2 patients), 3 (554 patients), 2 (21 patients), 1 (1 patient), 0 (1 patient). One patient with three seeds and two patients with <2 seeds had cone beam  CT  instead of  kV / kV  imaging for image guidance. No seeds were lost after simulation. The mean visual analogue pain score associated with transperineal gold seed insertion met patients' expectations (respectively 4.1 vs. 4.4  P  = 0.19).    Conclusion  Outpatient transperineal insertion of fiducials avoids the rectum, is effective, convenient, well tolerated and has few side effects.

journal of medical radiation sciences

Transperineal implantation of gold fiducial markers (gold seeds) for prostate image‐guided radiation therapy: a feasible technique associated with a low risk of complications