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Cardiac radioablation for ventricular tachycardia: Which approach for incorporating cardiorespiratory motions into the planning target volume?

Abstract : PURPOSE: To evaluate different approaches for generating a cardiorespiratory ITV for cardiac radioablation. METHODS: Four patients with ventricular tachycardia were included in this study. For each patient, cardiac-gated and respiration-correlated 4D-CT scans were acquired. The cardiorespiratory ITV was defined using registrations of the cardiac and respiratory 4D-CT images. Five different approaches, which differed in the number of incorporated cardiac phases (1, 2, 10, or 1 with a fixed 3 mm margin (FM) expansion) and respiratory phases (2 or 10), were evaluated. For each approach, a VMAT treatment plan was simulated. Target coverage (TC) and spill were evaluated geometrically and dosimetrically for each approach. RESULTS: When employing one cardiac phase, the TC did not exceed 85%. Using the two extreme phases of the cardiac and respiratory cycles resulted in a geometric TC < 88% for two patients, with a dosimetric TC of 83% for one patient. An acceptable TC for all patients (geometric TC > 89%, dosimetric TC > 92%) was only achieved when combining 10 respiratory phases with either 2 or 10 cardiac phases or a single cardiac phase with FM. The use of a single cardiac phase with FM combined with 10 respiratory phases lead to a mean geometric and dosimetric spill of 43% and 35%, respectively. CONCLUSION: For cardiac radioablation, the use of two extreme cardiac phases combined with 10 respiratory phases is a robust approach to generate a cardiorespiratory ITV. The use of a single cardiac phase with or without fixed margin expansion is not recommended based on this study.
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https://hal.archives-ouvertes.fr/hal-03554463
Contributor : Laurent Jonchère Connect in order to contact the contributor
Submitted on : Thursday, June 23, 2022 - 11:49:20 AM
Last modification on : Friday, June 24, 2022 - 10:56:41 AM

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Julien Bellec, Louis Rigal, Aurélien Hervouin, Raphaël Martins, Mathieu Lederlin, et al.. Cardiac radioablation for ventricular tachycardia: Which approach for incorporating cardiorespiratory motions into the planning target volume?. Physica Medica, Elsevier, 2022, 95, pp.16-24. ⟨10.1016/j.ejmp.2022.01.004⟩. ⟨hal-03554463⟩

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