Highlights
- •Cardiorespiratory ITV generated using cardiac-gated and respiratory-gated 4DCT.
- •Cardiorespiratory motions lead to an important increase of target volume in cardiac radioablation.
- •Combining 2 cardiac phases with 10 respiratory phases is a robust approach.
- •Using a single cardiac phase with our without fixed margin is a suboptimal approach.
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.
Keywords
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Article info
Publication history
Published online: January 20, 2022
Accepted:
January 11,
2022
Received in revised form:
January 10,
2022
Received:
October 10,
2021
Identification
Copyright
© 2022 Associazione Italiana di Fisica Medica e Sanitaria. Published by Elsevier Ltd. All rights reserved.
