Lung Fiducial Placement Marker in Curative Lung Cancer

What is a Fiducial Marker Placement?

Fiducial marker placement is a procedure where a small metal object (usually gold) is either placed into the tumour in your lung or near to it.

This is done through a camera (bronchoscopy) test in your lung.

The size of the marker is roughly the size of a grain of rice.

Why should I have this procedure?

Sometimes the tumour can be quite small and in a part of your lung that is difficult for a Surgeon to find. This makes it difficult for them to remove the tumour.

By using a fiducial marker, this allows the Surgeon to pinpoint the location of a tumour more accurately. This means that the treatment team (Cardiothoracic Surgeon or Oncologist) can either:

• resect (cut out) the tumour

or

• deliver maximum dosage of radiation to the tumour more accurately. This will reduce damage to nearby healthy tissue.

Are there any risks with this procedure?

There is a small risk (6 patients out of every 100) of the fiducial marker moving from where it has been placed. This does not normally cause any significant harm and it is likely that you will cough out the marker. Doctors can use a camera test to locate the marker.

Risks associated with the bronchoscopy include:

• Sore throat and hoarse voice

• Cough – It is common to cough during the procedure. We try to reduce this as much as possible by using local anaesthetic spray as we are inserting the camera. You may cough more often than normal for a few days after the test.

• Bruising in your eye – This is very rare. The cough can result in a bruising to the white of your eye. This is known as a subconjunctival haemorrhage. It can look worrying, but it is harmless and does not affect your eyesight. This will usually get better in 7 – 14 days.

• Damage to existing teeth or any dental work – This is rare. The chance of this happening is reduced by the removing any dentures before the test and by using a mouth guard.

• Breathing problems – This is rare. Your airways can be irritated by the test and go into spasm.

This is more likely in patients with pre-existing lung disease, such as asthma or COPD. You may require a nebuliser.

Some patients may take a longer time to recover after the procedure and you may need to be admitted to hospital for observation or further treatment.

• Heart Problems – This only happens in up to 5 out of every 100 patients. This procedure may put a brief minor strain on your heart. This can cause abnormal beating of your heart. Very rarely, this can cause fluid to collect in your lungs or a heart attack.

• Fever – This is common. It usually settles within 24 – 48 hours and paracetamol can be taken to treat this. Always stick to the recommended daily dose advice on the packet.

• Infection –  This only happens in less than 1 in 500 patients. Please contact your GP or Specialist Nurse if you have symptoms such as breathlessness, a cough that isn’t going away or is getting worse, new sputum (phlegm), or if you simply just don’t “feel right.”

• Bleeding –  This only happens to about 1 in every 1000 patients. Bleeding is usually minor and settles quickly.

If significant bleeding does happen, this may require the team to give medicine into your airways to control the bleeding.

It is very rare for any bleeding to be life threatening.

• Allergic reactions to sedative medicine or local anaesthetic spray.

• Death – This is very rare and only happens to less than 1 in 1000 patients. The risks are higher in patients who have very severe heart or breathing problems. Your team will have carefully weighed up the risk to your health before recommending this test to you.

It’s normal to feel quite anxious about the test after reading all of the possible risks and side effects. However, please be assured that the vast majority of patients who have this test have no problems during or after the test.

How should I prepare for the procedure?

Before the procedure, your Doctor will go through the usual check for bronchoscopy and advise you about what you need to do. There are no extra preparations needed for fiducial placement.

You may have had relatives or friends who have had other types of camera test done and this has made you worried. This is a simple and safe test and by telling you exactly how it is carried out, we hope that it puts you at ease.

On the day

You will need a friend or relative to bring you, collect you and stay with you overnight after you’ve been discharged.

If nobody is available to do this, then you will be admitted to hospital overnight.

Please wear comfortable clothing and remove nail varnish as this can interfere with the monitor used to read your oxygen levels. If you smoke, please try to avoid doing so on the day of the procedure as it can lower your oxygen levels during the procedure.

Bring all your medication (including over the counter remedies) and a list of any allergies.

You must tell us of any latex allergy you may have, as we use this during the procedure. We can still do the procedure without latex, but it requires special arrangements to be made in advance of your test.

If you are a woman of child-bearing age we ask you to tell us if you may be pregnant, we may ask you to have a pregnancy test. The reason for this is that the test involves the use of X-rays which could be harmful to a developing baby.

Please come to the Endoscopy department located on the lower ground floor of the South Wing at North Tees Hospital.

After booking in at reception, you will go through a checklist with a Nurse. A relative or friend may be able to sit with you during this conversation, but they won’t be able to accompany you into the procedure room while you are having your test.

The Nurse will ask you questions about your medical history, which medicines you take and what allergies you have. They will also do some simple checks of your pulse, blood pressure, oxygen levels and temperature.

You may have answered some of these questions before you came for the test, but these questions are to make sure that the test is carried out as safely as possible.

You will then be offered a seat in the Endoscopy waiting area so you may wish to bring a book or some music and headphones to keep yourself relaxed.

You will be given an appointment time, but the procedure may not take place at this exact time, depending on the number and type of cases we have.

We know it is worrying to sit and wait for a procedure, but sometimes cases take longer than expected. We will do our best to keep you informed on the day.

The Doctor will go through a consent form to ensure you understand the risks and benefits of having the procedure. You will have the chance to ask any questions you have at this time.

How will I feel after the procedure?

You should be able to go home, as long as you have someone to take care of you that night.

You will be monitored in the recovery area for up to 2 hours while the sedation and the local anaesthetic wears off.

When the Nurses looking after you are happy that you are well enough, you will usually be offered a drink and something to eat.

We occasionally arrange a repeat CT scan as an outpatient to confirm the location of the marker.

The marker will not react with your body and they usually do not set off airport scanners.

Is the marker MRI Compatible?

Cylindrical gold markers are MRI compatible.

Contact numbers

The Respiratory Department
Monday to Friday
09:00am-05:00pm
Telephone: 01642 624936

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

Opening hours: Monday to Friday, 9:30am to 4:00pm

Email: [email protected]

Out of hours

Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person.

Telephone: 01642 617617

Data protection and use of patient information

The Trust has developed Data Protection policies in accordance with Data Protection Legislation (UK General Data Protection Regulations and Data Protection Act 2018) and the Freedom of Information Act 2000. All of our staff respect these policies and confidentiality is adhered to at all times. If you require further information on how we process your information please see our Privacy Notices.

Telephone: 01642 383551

Email: [email protected]

Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]

Leaflet Reference: PIL1425
Date for Review: 08/03/2026