Would you offer liver SBRT without fiducial placement?

When we first started doing liver SBRT cases in the early Paleolithic 2000s (refs), we never used fiducials and just managed by using the nearest liver surface contour (or diaphragm if using a breath hold technique) and/or any other intrahepatic anatomy that was distinguishable once we added CBCT. I...

Great points by Dr. @Dr. First Last!

In my experience, fiducials increased the confidence of the whole team (therapy, physics, physician) when available for liver SBRT, and I used them for >90% of patients or more (Weiner et al., PMID 27566894). Of course, if MR-guided radiation is available, it's a...

At UAB, we use fiducials if at all possible, in conjunction with triggered kV imaging upon the opening of the gating phase. This allows for maximal precision of treatment.

The exception to this is if the patient has surgical clips (e.g., prior resection or biopsy) or if the patient has received rad...