TY - JOUR
T1 - Evaluation of Motion Compensation Methods for Noninvasive Cardiac Radioablation of Ventricular Tachycardia
AU - Prusator, Michael T.
AU - Samson, Pamela
AU - Cammin, Jochen
AU - Robinson, Clifford
AU - Cuculich, Phillip
AU - Knutson, Nels C.
AU - Goddu, S. Murty
AU - Moore, Kaitlin
AU - Hugo, Geoffrey D.
N1 - Funding Information:
Disclosures: G.D.H. reports grants from the American Heart Association during the conduct of the study; personal fees from Varian Medical Systems; and grants from Siemens, Varian Medical Systems, and Viewray, Inc, outside the submitted work. In addition, G.D.H. has a patent PCT/US2016/000103 licensed to Varian Medical Systems and a patent PCT/US2018/065278 licensed to Varian Medical Systems. C.R. reports grants and personal fees from Varian and other from Radialogica outside the submitted work. In addition, C.R. has a patent, “Noninvasive imaging and treatment system for cardiac arrhythmias,” WO 2017078757 A1, licensed to Varian, and a patent U.S. Provisional Application No. 62/598,162 entitled “System and method for determining segments for ablation” licensed to Varian. P.C. reports personal fees from Medtronic and Varian Medical Systems outside the submitted work. In addition, P.C. has a patent WO2017078757A1 licensed to Varian/Washington University and a patent US20180318606A1 licensed to Varian/Washington University. J.C. received a speaker honorarium from Siemens Healthineers.
Funding Information:
Disclosures: G.D.H. reports grants from the American Heart Association during the conduct of the study; personal fees from Varian Medical Systems; and grants from Siemens, Varian Medical Systems, and Viewray, Inc, outside the submitted work. In addition, G.D.H. has a patent PCT/US2016/000103 licensed to Varian Medical Systems and a patent PCT/US2018/065278 licensed to Varian Medical Systems. C.R. reports grants and personal fees from Varian and other from Radialogica outside the submitted work. In addition, C.R. has a patent, “Noninvasive imaging and treatment system for cardiac arrhythmias,” WO 2017078757 A1, licensed to Varian, and a patent U.S. Provisional Application No. 62/598,162 entitled “System and method for determining segments for ablation” licensed to Varian. P.C. reports personal fees from Medtronic and Varian Medical Systems outside the submitted work. In addition, P.C. has a patent WO2017078757A1 licensed to Varian/Washington University and a patent US20180318606A1 licensed to Varian/Washington University. J.C. received a speaker honorarium from Siemens Healthineers.
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/11/15
Y1 - 2021/11/15
N2 - Purpose: Noninvasive cardiac radioablation is increasingly used for treatment of refractory ventricular tachycardia. Attempts to limit normal tissue exposure are important, including managing motion of the target. An interplay between cardiac and respiratory motion exists for cardiac radioablation, which has not been studied in depth. The objectives of this study were to estimate target motion during abdominal compression free breathing (ACFB) and respiratory gated (RG) deliveries and to investigate the quality of either implanted cardioverter defibrillator lead tip or the diaphragm as a gating surrogate. Methods and Materials: Eleven patients underwent computed tomography (CT) simulation with an ACFB 4-dimensional CT (r4DCT) and an exhale breath-hold cardiac 4D-CT (c4DCT). The target, implanted cardioverter defibrillator lead tip and diaphragm trajectories were measured for each patient on the r4DCT and c4DCT using rigid registration of each 4D phase to the reference (0%) phase. Motion ranges for ACFB and exhale (40%-60%) RG delivery were estimated from the target trajectories. Surrogate quality was estimated as the correlation with the target motion magnitudes. Results: Mean (range) target motion across patients from r4DCT was as follows: left/right (LR), 3.9 (1.7-6.9); anteroposterior (AP), 4.1 (2.2-5.4); and superoinferior (SI), 4.7 (2.2-7.9) mm. Mean (range) target motion from c4DCT was as follows: LR, 3.4 (1.0-4.8); AP, 4.3 (2.6-6.5); and SI, 4.1 (1.4-8.0) mm. For an ACFB, treatment required mean (range) margins to be 4.5 (3.1-6.9) LR, 4.8 (3-6.5) AP, and 5.5 (2.3-8.0) mm SI. For RG, mean (range) internal target volume motion would be 3.6 (1.1-4.8) mm LR, 4.3 (2.6-6.5) mm AP, and 4.2 (2.2-8.0) mm SI. The motion correlations between the surrogates and target showed a high level of interpatient variability. Conclusions: In ACFB patients, a simulated exhale-gated approach did not lead to large projected improvements in margin reduction. Furthermore, the variable correlation between readily available gating surrogates could mitigate any potential advantage to gating and should be evaluated on a patient-specific basis.
AB - Purpose: Noninvasive cardiac radioablation is increasingly used for treatment of refractory ventricular tachycardia. Attempts to limit normal tissue exposure are important, including managing motion of the target. An interplay between cardiac and respiratory motion exists for cardiac radioablation, which has not been studied in depth. The objectives of this study were to estimate target motion during abdominal compression free breathing (ACFB) and respiratory gated (RG) deliveries and to investigate the quality of either implanted cardioverter defibrillator lead tip or the diaphragm as a gating surrogate. Methods and Materials: Eleven patients underwent computed tomography (CT) simulation with an ACFB 4-dimensional CT (r4DCT) and an exhale breath-hold cardiac 4D-CT (c4DCT). The target, implanted cardioverter defibrillator lead tip and diaphragm trajectories were measured for each patient on the r4DCT and c4DCT using rigid registration of each 4D phase to the reference (0%) phase. Motion ranges for ACFB and exhale (40%-60%) RG delivery were estimated from the target trajectories. Surrogate quality was estimated as the correlation with the target motion magnitudes. Results: Mean (range) target motion across patients from r4DCT was as follows: left/right (LR), 3.9 (1.7-6.9); anteroposterior (AP), 4.1 (2.2-5.4); and superoinferior (SI), 4.7 (2.2-7.9) mm. Mean (range) target motion from c4DCT was as follows: LR, 3.4 (1.0-4.8); AP, 4.3 (2.6-6.5); and SI, 4.1 (1.4-8.0) mm. For an ACFB, treatment required mean (range) margins to be 4.5 (3.1-6.9) LR, 4.8 (3-6.5) AP, and 5.5 (2.3-8.0) mm SI. For RG, mean (range) internal target volume motion would be 3.6 (1.1-4.8) mm LR, 4.3 (2.6-6.5) mm AP, and 4.2 (2.2-8.0) mm SI. The motion correlations between the surrogates and target showed a high level of interpatient variability. Conclusions: In ACFB patients, a simulated exhale-gated approach did not lead to large projected improvements in margin reduction. Furthermore, the variable correlation between readily available gating surrogates could mitigate any potential advantage to gating and should be evaluated on a patient-specific basis.
UR - http://www.scopus.com/inward/record.url?scp=85111500748&partnerID=8YFLogxK
U2 - 10.1016/j.ijrobp.2021.06.035
DO - 10.1016/j.ijrobp.2021.06.035
M3 - Article
C2 - 34217790
AN - SCOPUS:85111500748
SN - 0360-3016
VL - 111
SP - 1023
EP - 1032
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 4
ER -