Patient Guide · Gold-Marker Placement
Your radiotherapy team has recommendedgold markers.Here's what to expect.
Gold-marker placement is a short day-care procedure that happensbefore your radiotherapy begins. The markers are tiny — about the size of a grain of rice — and they let the treatment machine target your tumour with millimetre-level accuracy every single day. This page walks you through the procedure, how to prepare, what to expect afterwards, and the questions worth asking your care team. Written for patients and their families, not for clinicians.
Important: this page is educational. It does not replace the specific advice of your radiation-oncology team, who know your medical history and imaging. Always follow their instructions in preference to anything on this page.
Why this step matters
Small markers, big difference to your treatment
Modern radiotherapy needs a target the machine can see
Cancer inside soft organs (prostate, liver, lung, pancreas) moves — with breathing, with bowel filling, day-to-day. Bone landmarks alone are not accurate enough for the tight margins that modern IGRT and SBRT use. Implanted gold markers give the treatment machine a stable, visible target so the beam corrects to your actual tumour position before every session.
Smaller margins mean less healthy tissue in the beam
Without markers, the radiation-oncology team must add a safety margin around the tumour to cover the uncertainty about where it will be on each treatment day. With markers, that margin can shrink — meaning less bladder, less rectum, less lung and less healthy liver in the treatment field, and fewer long-term side effects for you.
Enables hypofractionation and SBRT
The high-dose short-course treatments (5 to 20 sessions instead of 30–40 for prostate, or a single session for some liver lesions) are only safe with millimetre-level targeting. Fiducial markers are what make those treatments possible — the difference between a six-week course and a one-week course often comes down to whether markers can be placed.
The procedure, step by step
From arrival to going home — about half a day, mostly waiting
- 1
Before you arrive
The day-care nurse will call you the day before to confirm your arrival time, ask about any blood-thinning medicines you take, and remind you not to eat for the number of hours your team specifies. If you take anticoagulants (aspirin, clopidogrel, warfarin, apixaban etc.), do not stop them on your own — your radiation-oncology team will tell you which ones to hold and for how long, based on why you take them.
- 2
On the day
You will change into a hospital gown, meet the interventional radiologist (or urologist / hepatologist depending on the organ), and lie on the imaging couch. A small area of skin is cleaned and numbed with local anaesthetic — like the injection you get at the dentist. Most patients stay awake; some centres offer light sedation on request.
- 3
Placing the markers
A very thin needle (about the same width as a diagnostic biopsy needle) is guided through the skin to the tumour under real-time imaging — usually ultrasound or CT. Three or four small gold markers are placed inside or right next to the tumour. You may feel gentle pressure. Each marker takes about a minute to deploy; the whole procedure is typically finished in 15 to 30 minutes.
- 4
Rest and go home
You will rest in the recovery area for one to two hours while the team checks the placement site and confirms you feel well. A short imaging scan may be repeated to verify each marker is in the correct position. Most patients leave the same day; a small dressing covers the needle site.
- 5
The days after
Mild soreness or a small bruise where the needle went in is normal for one to three days — the same as after a routine blood test at a slightly larger scale. You can shower after 24 hours. Contact the team if you notice significant bleeding, spreading redness, fever above 38 °C, or new severe pain.
- 6
CT-simulation, then treatment
Your CT-simulation scan for planning your radiotherapy is usually scheduled 5 to 10 days after marker placement — enough time for any swelling to settle so the plan is drawn on your normal anatomy. Treatment itself begins one to three weeks after simulation. The markers stay in place for the rest of your life; they are made of medical-grade gold and cause no problems on future MRI or CT scans.
How to prepare
The day before, and the morning of your procedure
Medicines to review
Bring a full list of every medicine, supplement and herbal remedy you take to the pre-procedure appointment. The team will tell you which blood-thinning medicines to hold and for how long — do not stop any medicine on your own.
Food and drink
Follow the fasting instructions your team gives you (usually 4–6 hours for the placement itself; longer if you will receive sedation). Sipping small amounts of water is usually allowed up to 2 hours before.
Bring a companion
Even without sedation, plan for someone to drive you home. If you receive light sedation, you should not drive for 24 hours.
Skin and clothing
Wear loose, comfortable clothing you can put back on easily. Do not apply lotion, powder or perfume on the day of the procedure. Long hair may need to be tied back.
What to bring
Photo ID, insurance / TPA card, referral letter from your oncologist, and the prior imaging (CT / MRI) your team asked you to bring. A phone charger and a book — the wait in recovery is often the longest part of the day.
Ask about pregnancy
If there is any chance you may be pregnant, tell the team before the procedure — the imaging used to guide placement involves X-rays. A urine pregnancy test may be done to confirm.
Not all fiducial markers are the same
What makes a modern gold-marker design worth asking about
Older cylindrical gold seeds are still in use in some centres. The Gold Anchor™ family uses a folding gold-iron wire design that improves on the older seed in four ways worth knowing about, especially if you are having lung or liver marker placement.
Thin-needle placement
The Gold Anchor marker is designed to fold into a very compact shape on deployment, so it can be delivered through a needle about half the diameter of the needles used for older cylindrical gold-seed markers. A thinner needle means less bleeding risk, less discomfort, and (in the lung) a substantially lower chance of a collapsed lung (pneumothorax) at placement.
Very low marker movement after placement
Once placed, the marker locks into the surrounding tissue and stays where it was put. Published long-term studies report about 0.3 % marker displacement over 5 years of follow-up — meaning the position the radiation team plans against on day 1 is the same position the machine sees on day 30.
Visible on every modern imaging modality
The marker is visible on CT, MRI, ultrasound, X-ray and cone-beam CT (the imaging built into the treatment machine). MRI visibility matters especially for prostate treatment planning, where centres increasingly use MRI-only workflows — the older pure-gold markers were invisible on MRI, but the gold-iron alloy in the Gold Anchor family produces a distinctive MRI signature.
Safe for the rest of your life
The markers are made of medical-grade gold alloy that is chemically inert — they do not corrode, do not release any substance into the body, and do not trigger allergic reactions. They will show up on future imaging (CT, MRI, dental X-rays) but do not interfere with any scan and cause no artefacts on airport security scanners.
Migration and MRI-detection figures above are drawn from published peer-reviewed studies across prostate, liver and lung radiotherapy cohorts. See theclinical evidence libraryfor the source studies — 22 papers in total.
Precautions + after-care
What to watch for, and what is normal
Signs to call the team about
Heavy bleeding from the needle site that does not stop with pressure; spreading redness or warmth beyond the immediate site; fever above 38 °C in the first 48 hours; new severe pain (especially chest pain or shortness of breath after a lung procedure). Your team will give you a 24-hour contact number — use it.
Bleeding + bruise expectations
A small bruise or firm lump at the needle site is normal for 1–3 days. Take paracetamol for discomfort. Avoid ibuprofen and other anti-inflammatory painkillers for the first 48 hours unless your team specifies otherwise, because they thin the blood.
Wound care
Keep the dressing dry for 24 hours; you can shower after that. Do not soak in a bath, pool or the sea for 5–7 days. No heavy lifting or vigorous exercise for 48 hours.
You are not radioactive
The markers themselves are not radioactive. They do not emit any radiation and do not put anyone near you (family, children, pregnant women) at any risk. This is different from radionuclide therapy where the medicine itself is radioactive — fiducial markers are just tiny pieces of metal.
Airports and future imaging
The markers are too small to trigger airport security scanners. If you have future MRI scans, the markers are MR-conditional up to 3 Tesla — they will show up but are completely safe in the scanner. Tell any future doctor about the markers when you have imaging.
Questions to ask your care team
Six questions worth writing down
Take this list to your pre-procedure appointment. You will be given a lot of information at once — a written list of the questions that matter to you helps make sure nothing slips through.
- ❓How many gold-marker placements has your interventional radiologist done?
- ❓What type of fiducial marker does the department use — a modern fold-anchor design or the older cylindrical seed?
- ❓How long is the gap between marker placement and my CT-simulation scan?
- ❓When will my treatment start, and how many treatment sessions am I likely to have?
- ❓What blood-thinning medicines do I need to hold, and for how long?
- ❓What are the specific warning signs after placement — and what number should I call at night or on weekends?
Availability across India
Ask your radiation-oncology team whether they use the Gold Anchor marker
The Gold Anchor™ family is supplied and supported across India by Saxsons Group. If your treating hospital does not currently stock it, your radiation-oncology team can request it — most Indian centres running SBRT and IGRT prostate / liver / lung programmes already have it on their shelf. Choice of marker is a clinical decision for your team; this page exists so you can ask an informed question.
This page is educational and does not constitute medical advice. Always follow the instructions of your treating radiation-oncology team.