Physics and imaging in radiation oncology · 2025
Electrocardiogram-gated cardiac computed tomography-based patient- and segment-specific cardiac motion estimation method in stereotactic arrhythmia radioablation for ventricular tachycardia.
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Xie Jingyang, Bicu Alicia S, Grehn Melanie, Kuru Mustafa, Zaman Adrian, Lu Xinyu, Janorschke Christian, van der Pol Luuk H G, Fast Martin F, Fleckenstein Jens, Both Marcus, Hohmann Stephan, Borzov Egor, Winkler Peter, Tilz Roland R, Rades Dirk, Giordano Frank A, Buergy Daniel, Rudic Boris, Duncker David, Merten Roland, Charas Tomer, Suleiman Mahmoud, Brunner Thomas, Scherr Daniel, Lian Evgeny, Schweikard Achim, Blanck Oliver, Boda-Heggemann Judit, Kaestner Lena
Аннотация
BACKGROUND AND PURPOSE: Motion management strategies such as gating under breath-hold can reduce breathing-induced motion during stereotactic arrhythmia radioablation (STAR) for refractory ventricular tachycardia. However, heartbeat-induced motion is essential to define an appropriate cardiac internal target volume (ITV) margin. In this study, we introduce a patient- and segment-specific cardiac motion estimation method and cardiac motion data of the clinical target volume (CTV), ICD lead tips and left ventricle (LV) segments.
MATERIALS AND METHODS: Data from 10 STAR-treated patients were retrospectively analyzed. The LV was semi-automatically segmented according to the 17-segment model. Electrocardiogram-gated contrast-enhanced breath-hold cardiac CTs were automatically non-rigidly registered for motion estimation. The correlation and significant differences between ICD tip motion and CTV motion were assessed using the Pearson correlation coefficient (PCC) and Wilcoxon signed-rank test, while spatial discrepancies with both CTV and segment motion were quantified using the Euclidean distance.
RESULTS: The CTVs (center of mass) moved 3.4 ± 1.4 mm and the ICD lead tips moved 4.9 ± 2.2 mm. The maximum motion per patient was observed in basal and mid-cavity LV segments in 3D. The PCC showed a strong positive motion correlation between the ICD tip and CTV in 3D (0.84), while the p-values indicated statistically significant differences in the right-left, anterior-posterior and 3D directions.
CONCLUSION: The proposed methods enable patient- and segment-specific cardiac ITV margin estimation. The motion in most LV segments was limited, however, cardiac ITV margins may need adjustment in individual cases. The impact of cardiac motion on the dosimetry needs further investigation.
MATERIALS AND METHODS: Data from 10 STAR-treated patients were retrospectively analyzed. The LV was semi-automatically segmented according to the 17-segment model. Electrocardiogram-gated contrast-enhanced breath-hold cardiac CTs were automatically non-rigidly registered for motion estimation. The correlation and significant differences between ICD tip motion and CTV motion were assessed using the Pearson correlation coefficient (PCC) and Wilcoxon signed-rank test, while spatial discrepancies with both CTV and segment motion were quantified using the Euclidean distance.
RESULTS: The CTVs (center of mass) moved 3.4 ± 1.4 mm and the ICD lead tips moved 4.9 ± 2.2 mm. The maximum motion per patient was observed in basal and mid-cavity LV segments in 3D. The PCC showed a strong positive motion correlation between the ICD tip and CTV in 3D (0.84), while the p-values indicated statistically significant differences in the right-left, anterior-posterior and 3D directions.
CONCLUSION: The proposed methods enable patient- and segment-specific cardiac ITV margin estimation. The motion in most LV segments was limited, however, cardiac ITV margins may need adjustment in individual cases. The impact of cardiac motion on the dosimetry needs further investigation.