{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T10:34:01Z","timestamp":1792406041491,"version":"4.4.0"},"reference-count":9,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,5,16]],"date-time":"2023-05-16T00:00:00Z","timestamp":1684195200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Fiducial markers are utilized for image guided radiotherapy (IGRT) alignment during the delivery of liver stereotactic body radiosurgery (SBRT). There are limited data demonstrating the impact of matching fiducials on the accuracy of liver SBRT. This study quantifies the benefit of fiducial-based alignment and improvements in inter-observer reliability. Nineteen patients with 24 liver lesions were treated with SBRT. Target localization was performed using fiducial markers on cone-beam computed tomography (CBCT). Each CBCT procedure was retrospectively realigned to match both the liver edge and fiducial markers. The shifts were recorded by seven independent observers. Inter-observer variability was analyzed by calculating the mean error and uncertainty for the set-up. The mean absolute Cartesian error observed from fiducial and liver edge-based alignment was 1.5 mm and 5.3 mm, respectively. The mean uncertainty from fiducial and liver edge-based alignment was 1.8 mm and 4.5 mm, respectively. An error of 5 mm or greater was observed 50% of the time when aligning to the liver surface versus 5% of the time when aligning to fiducial markers. Aligning to the liver edge significantly increased the error, resulting in increased shifts when compared to alignment to fiducials. Tumors of 3 cm or farther from the liver dome had higher mean errors when aligned without fiducials (4.8 cm vs. 4.4 cm, p = 0.003). Our data support the use of fiducial markers for safer and more accurate liver SBRT.<\/jats:p>","DOI":"10.3390\/curroncol30050382","type":"journal-article","created":{"date-parts":[[2023,5,16]],"date-time":"2023-05-16T02:45:47Z","timestamp":1684205147000},"page":"5054-5061","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Fiducial Markers Allow Accurate and Reproducible Delivery of Liver Stereotactic Body Radiation Therapy"],"prefix":"10.3390","volume":"30","author":[{"given":"Marina","family":"Moskalenko","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard L.","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Mueller","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA 19107, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shirley","family":"Lewis","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Oncology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay C.","family":"Shiao","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara J.","family":"Zakem","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University of Washington, Seattle, WA 98195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler P.","family":"Robin","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4576-6355","authenticated-orcid":false,"given":"Karyn A.","family":"Goodman","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1016\/j.ijrobp.2017.12.014","article-title":"Comparison of Stereotactic Body Radiation Therapy and Radiofrequency Ablation in the Treatment of Intrahepatic Metastases","volume":"100","author":"Jackson","year":"2018","journal-title":"Int. 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Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.semradonc.2017.02.004","article-title":"Stereotactic Body Radiotherapy for Liver Metastases","volume":"27","author":"Goodman","year":"2017","journal-title":"Semin. Radiat. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1080\/0284186X.2017.1288925","article-title":"Cone beam CT-based set-up strategies with and without rotational correction for stereotactic body radiation therapy in the liver","volume":"56","author":"Bertholet","year":"2017","journal-title":"Acta Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"5445","DOI":"10.1088\/0031-9155\/56\/17\/001","article-title":"Treatment precision of image-guided liver SBRT using implanted fiducial markers depends on marker-tumour distance","volume":"56","author":"Seppenwoolde","year":"2011","journal-title":"Phys. Med. 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Cancer"}],"container-title":["Current Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1718-7729\/30\/5\/382\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:35:47Z","timestamp":1760124947000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1718-7729\/30\/5\/382"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,16]]},"references-count":9,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,5]]}},"alternative-id":["curroncol30050382"],"URL":"https:\/\/doi.org\/10.3390\/curroncol30050382","relation":{},"ISSN":["1718-7729"],"issn-type":[{"value":"1718-7729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,16]]}}}