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Cardiorespiratory motion characteristics and their dosimetric impact on cardiac stereotactic body radiotherapy

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机构: [1]Sichuan Univ, West China Hosp, Canc Ctr, Dept Radiat Oncol, 37 Guoxue Alley, Chengdu 610041, Sichuan, Peoples R China [2]Sichuan Univ, West China Hosp, Dept Radiotherapy Phys & Technol, Chengdu, Sichuan, Peoples R China [3]Sun Yat Sen Univ, Guangdong Prov Clin Res Ctr Canc, Canc Ctr, State Key Lab Oncol South China, Guangzhou, Peoples R China [4]Soochow Univ, Affiliated Hosp 1, Inst Radiotherapy & Oncol, Dept Radiotherapy & Oncol, Suzhou, Peoples R China [5]Soochow Univ, Affiliated Hosp 2, Dept Radiotherapy & Oncol, Suzhou, Peoples R China
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关键词: 4D cardiac computed tomography 4D dose reconstruction cardiac pulsation refractory arrhythmias stereotactic body radiotherapy

摘要:
Background: Cardiac stereotactic body radiotherapy (CSBRT) is an emerging and promising noninvasive technique for treating refractory arrhythmias utilizing highly precise, single or limited-fraction high-dose irradiations. This method promises to revolutionize the treatment of cardiac conditions by delivering targeted therapy with minimal exposure to surrounding healthy tissues. However, the dynamic nature of cardiorespiratory motion poses significant challenges to the precise delivery of dose in CSBRT, introducing potential variabilities that can impact treatment efficacy. The complexities of the influence of cardiorespiratory motion on dose distribution are compounded by interplay and blurring effects, introducing additional layers of dose uncertainty. These effects, critical to the understanding and improvement of the accuracy of CSBRT, remain unexplored, presenting a gap in current clinical literature. Purpose: To investigate the cardiorespiratory motion characteristics in arrhythmia patients and the dosimetric impact of interplay and blurring effects induced by cardiorespiratory motion on CSBRT plan quality. Methods: The position and volume variations in the substrate target and cardiac substructures were evaluated in 12 arrhythmia patients using displacement maximum (DMX) and volume metrics. Moreover, a four-dimensional (4D) dose reconstruction approach was employed to examine the dose uncertainty of the cardiorespiratory motion. Results: Cardiac pulsation induced lower DMX than respiratory motion but increased the coefficient of variation and relative range in cardiac substructure volumes. The mean DMX of the substrate target was 0.52 cm (range: 0.26-0.80 cm) for cardiac pulsation and 0.82 cm (range: 0.32-2.05 cm) for respiratory motion. The mean DMX of the cardiac structure ranged from 0.15 to 1.56 cm during cardiac pulsation and from 0.35 to 1.89 cm during respiratory motion. Cardiac pulsation resulted in an average deviation of -0.73% (range: -4.01%-4.47%) in V-25 between the 3D and 4D doses. The mean deviations in the homogeneity index (HI) and gradient index (GI) were 1.70% (range: -3.10%-4.36%) and 0.03 (range: -0.14-0.11), respectively. For cardiac substructures, the deviations in D-50 due to cardiac pulsation ranged from -1.88% to 1.44%, whereas the deviations in D-max ranged from -2.96% to 0.88% of the prescription dose. By contrast, the respiratory motion led to a mean deviation of -1.50% (range: -10.73%-4.23%) in V-25. The mean deviations in HI and GI due to respiratory motion were 4.43% (range: -3.89%-13.98%) and 0.18 (range: -0.01-0.47) (p < 0.05), respectively. Furthermore, the deviations in D-50 and D-max in cardiac substructures for the respiratory motion ranged from -0.28% to 4.24% and -4.12% to 1.16%, respectively. Conclusions: Cardiorespiratory motion characteristics vary among patients, with the respiratory motion being more significant. The intricate cardiorespiratory motion characteristics and CSBRT plan complexity can induce substantial dose uncertainty. Therefore, assessing individual motion characteristics and 4D dose reconstruction techniques is critical for implementing CSBRT without compromising efficacy and safety.

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出版当年[2023]版:
大类 | 2 区 医学
小类 | 3 区 核医学
最新[2023]版:
大类 | 2 区 医学
小类 | 3 区 核医学
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出版当年[2023]版:
Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
最新[2023]版:
Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

影响因子: 最新[2023版] 最新五年平均 出版当年[2023版] 出版当年五年平均 出版前一年[2023版]

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第一作者机构: [1]Sichuan Univ, West China Hosp, Canc Ctr, Dept Radiat Oncol, 37 Guoxue Alley, Chengdu 610041, Sichuan, Peoples R China [2]Sichuan Univ, West China Hosp, Dept Radiotherapy Phys & Technol, Chengdu, Sichuan, Peoples R China [*1]Department of Radiation Oncology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
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通讯机构: [1]Sichuan Univ, West China Hosp, Canc Ctr, Dept Radiat Oncol, 37 Guoxue Alley, Chengdu 610041, Sichuan, Peoples R China [2]Sichuan Univ, West China Hosp, Dept Radiotherapy Phys & Technol, Chengdu, Sichuan, Peoples R China [*1]Department of Radiation Oncology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
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