Analyzing Cardiorespiratory Motion and Its Dosimetric Effect on Stereotactic Arrhythmia Radio-Ablation: A STOPSTORM.eu Consortium Study
- van der Pol, Luuk H G1
- Mandija, Stefano1
- Balgobind, Brian V2
- Blamek, Slawomir3
- Boda-Heggemann, Judit4
- Christoph, Marian5
- Cvek, Jakub6
- de Areba Iglesias, Javier7
- Dvorak, Pavel6
- Grehn, Melanie8
- Hazelaar, Colien9
- Klautke, Gunther10
- Knybel, Lukáš6
- Miszczyk, Marcin11
- Sajdok, Mateusz12, 13
- Visser, Jorrit2
- Tomasik, Bartłomiej14
- Blanck, Oliver8
- Fast, Martin F1
- 1. Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
- 2. Department of Radiation Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- 3. Department of Radiotherapy, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice, Poland
- 4. Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- 5. Department for Cardiology and Angiology, Klinikum Chemnitz, Klinik für Innere Medizin I, Chemnitz, Germany
- 6. Department of Oncology, University Hospital and Faculty of Medicine, Ostrava, Czech Republic
- 7. Department of Medical Physics, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
- 8. Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
- 9. Department of Radiation Oncology (Maastro), GROW Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
- 10. Radiotherapy Center, Klinikum Chemnitz, Klinik für Radioonkologie, Chemnitz, Germany
- 11. Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany; Faculty of Medicine, WSB University, Dąbrowa Górnicza, Poland; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- 12. Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland; Department of Electrocardiology, Upper Silesian Medical Center of the Medical University of Silesia, Katowice, Poland
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13.
"Institute" Energosetproject"
- 14. Department of Radiotherapy, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice, Poland; Department of Oncology and Radiotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
Description
Abstract
Purpose: Stereotactic arrhythmia radio-ablation (STAR) is increasingly used to treat refractory ventricular tachycardia. The importance of cardiorespiratory motion during STAR is still poorly understood. We collected multicenter STOPSTORM.eu data to estimate cardiorespiratory motion and its dosimetric impact on STAR-deliveries.
Methods and materials: Data were collected from 61 ventricular tachycardia patients. Treatments were performed in free-breathing (FB) with an internal-target volume (FB:ITV) (25 patients), in FB with respiratory beam tracking (FB:TR) (11 patients), using abdominal compression (AC) (10 patients), or in deep inspiration breath-hold (BH) (15 patients). Reference computed tomography images were registered to all breathing/cardiac phases, and the resulting deformation vector fields were used to extract motion for target structures and auto-contoured cardiorespiratory structures (CSs). Additionally, CS were auto-contoured on all breathing/cardiac phases to extract motion independently. Inverse deformation vector fields were used to accumulate motion-adjusted dose distributions. Dose differences were estimated using the conformity index: (VPTV25Gy)2/(VPTV · V25Gy), for planning target volume, and maximum and mean dose differences for CS.
Results: The median 95th percentile planning target volume motion was comparable between patients, with 6.0 mm (FB), 5.6 mm (AC), and 4.9 mm (BH). The left ventricle had the highest median 95th percentile motion out of all CS, with 6.8 mm (FB), 5.5 mm (AC), and 5.9 mm (BH). Estimated motion values were comparable between deformable image registration and auto-contouring (FB, 2.9-7.6 vs 3.1-8.5 mm; AC, 2.4-15.1 vs 3.0-9.0 mm; BH, 1.0-7.3 vs 2.4-6.7 mm). Median conformity index was reduced in the accumulated dose compared to the planned dose by: FB:ITV (-7.2%), AC (-14.1%), BH (-4.3%), and FB:TR (-1.3%). Mean CS dose increased by up to 2 Gy, and maximum dose increased by up to 1.2 Gy (excluding outliers). The largest dose differences were found for small CS.
Conclusions: Motion and its dosimetric effect have similar magnitudes between treatment setups. Motion findings were consistent between deformable image registration and auto-contouring. Only tracking significantly limited the dosimetric impact of motion.
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Analyzing Cardiorespiratory Motion and Its Dosimetric Effect on Stereotactic Arrhythmia Radio Ablation A STOPSTORMeu Consortium Study (In Press).pdf
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