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Balaji P, Liulu X, Sivakumar S, Chong JJH, Kizana E, Vandenberg JI, Hill AP, Hau E, Qian PC. Mechanistic insights and knowledge gaps in the effects of radiation therapy on cardiac arrhythmias. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)03316-9. [PMID: 39222823 DOI: 10.1016/j.ijrobp.2024.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 08/05/2024] [Accepted: 08/18/2024] [Indexed: 09/04/2024]
Abstract
Stereotactic body radiation therapy (SBRT) is an innovative modality for treatment of refractory ventricular arrhythmias (VA). Phase I/II clinical trials have demonstrated the remarkable efficacy of SBRT at reducing VA burden(by>85%) in patients with good short-term safety. SBRT as an option for VA treatment delivered in an ambulatory, non-sedated patient in a single fraction, during an outpatient session of 15-30 minutes, without added risks of anesthetic or surgery is clinically relevant. However, the underlying mechanism remains unclear. Currently used clinical dosing of SBRT has been derived from preclinical studies aimed to induce transmural fibrosis in the atria. The propitious clinical effects of SBRT appear earlier than the time-course for fibrosis. This review addresses the plausible mechanisms by which radiation alters the electrophysiological properties of myocytes and myocardial conduction to impart an anti-arrhythmic effect to elucidate clinical observations and point the direction for further research in this promising area.
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Affiliation(s)
- Poornima Balaji
- Cardiology Department, Westmead Hospital, University of Sydney, Westmead, NSW 2145, Australia; Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
| | - Xingzhou Liulu
- Cardiology Department, Westmead Hospital, University of Sydney, Westmead, NSW 2145, Australia; Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Sonaali Sivakumar
- Cardiology Department, Westmead Hospital, University of Sydney, Westmead, NSW 2145, Australia; Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
| | - James J H Chong
- Cardiology Department, Westmead Hospital, University of Sydney, Westmead, NSW 2145, Australia; Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia; Centre for Heart Research, The Westmead Institute for Medical Research, Westmead, NSW 2145, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Eddy Kizana
- Cardiology Department, Westmead Hospital, University of Sydney, Westmead, NSW 2145, Australia; Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia; Centre for Heart Research, The Westmead Institute for Medical Research, Westmead, NSW 2145, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Jamie I Vandenberg
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW 2010, Australia
| | - Adam P Hill
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW 2010, Australia
| | - Eric Hau
- Translational Radiation Biology and Oncology Laboratory, Centre for Cancer Research, The Westmead Institute for Medical Research, Westmead, NSW 2145, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, NSW, Westmead, Australia; Blacktown Hematology and Cancer Centre, Blacktown Hospital, NSW, Blacktown, Australia
| | - Pierre C Qian
- Cardiology Department, Westmead Hospital, University of Sydney, Westmead, NSW 2145, Australia; Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
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Puvanasunthararajah S, Camps SM, Wille ML, Fontanarosa D. Combined clustered scan-based metal artifact reduction algorithm (CCS-MAR) for ultrasound-guided cardiac radioablation. Phys Eng Sci Med 2022; 45:1273-1287. [PMID: 36352318 DOI: 10.1007/s13246-022-01192-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022]
Abstract
Cardiac radioablation is a promising treatment for cardiac arrhythmias, but accurate dose delivery can be affected by heart motion. For this reason, real-time cardiac motion monitoring during radioablation is of paramount importance. Real-time ultrasound (US) guidance can be a solution. The US-guided cardiac radioablation workflow can be simplified by the simultaneous US and planning computed tomography (CT) acquisition, which can result in US transducer-induced metal artifacts on the planning CT scans. To reduce the impact of these artifacts, a new metal artifact reduction (MAR) algorithm (named: Combined Clustered Scan-based MAR [CCS-MAR]) has been developed and compared with iMAR (Siemens), O-MAR (Philips) and MDT (ReVision Radiology) algorithms. CCS-MAR is a fully automated sinogram inpainting-based MAR algorithm, which uses a two-stage correction process based on a normalized MAR method. The second stage aims to correct errors remaining from the first stage to create an artifact-free combined clustered scan for the process of metal artifact reduction. To evaluate the robustness of CCS-MAR, conventional CT scans and/or dual-energy CT scans from three anthropomorphic phantoms and transducers with different sizes were used. The performance of CCS-MAR for metal artifact reduction was compared with other algorithms through visual comparison, image quality metrics analysis, and HU value restoration evaluation. The results of this study show that CCS-MAR effectively reduced the US transducer-induced metal artifacts and that it improved HU value accuracy more or comparably to other MAR algorithms. These promising results justify future research into US transducer-induced metal artifact reduction for the US-guided cardiac radioablation purposes.
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Affiliation(s)
- Sathyathas Puvanasunthararajah
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia. .,Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, Australia.
| | | | - Marie-Luise Wille
- Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, Australia.,School of Mechanical, Medical & Process Engineering, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD, Australia.,ARC ITTC for Multiscale 3D Imaging, Modelling, and Manufacturing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Davide Fontanarosa
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.,Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, Australia
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Franzetti J, Volpe S, Catto V, Conte E, Piccolo C, Pepa M, Piperno G, Camarda AM, Cattani F, Andreini D, Tondo C, Jereczek-Fossa BA, Carbucicchio C. Stereotactic Radiotherapy Ablation and Atrial Fibrillation: Technical Issues and Clinical Expectations Derived From a Systematic Review. Front Cardiovasc Med 2022; 9:849201. [PMID: 35592393 PMCID: PMC9110686 DOI: 10.3389/fcvm.2022.849201] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Aim The purpose of this study is to collect available evidence on the feasibility and efficacy of stereotactic arrhythmia radio ablation (STAR), including both photon radiotherapy (XRT) and particle beam therapy (PBT), in the treatment of atrial fibrillation (AF), and to provide cardiologists and radiation oncologists with a practical overview on this topic. Methods Three hundred and thirty-five articles were identified up to November 2021 according to preferred reporting items for systematic reviews and meta-analyses criteria; preclinical and clinical studies were included without data restrictions or language limitations. Selected works were analyzed for comparing target selection, treatment plan details, and the accelerator employed, addressing workup modalities, acute and long-term side-effects, and efficacy, defined either by the presence of scar or by the absence of AF recurrence. Results Twenty-one works published between 2010 and 2021 were included. Seventeen studies concerned XRT, three PBT, and one involved both. Nine studies (1 in silico and 8 in vivo; doses ranging from 15 to 40 Gy) comprised a total of 59 animals, 12 (8 in silico, 4 in vivo; doses ranging from 16 to 50 Gy) focused on humans, with 9 patients undergoing STAR: average follow-up duration was 5 and 6 months, respectively. Data analysis supported efficacy of the treatment in the preclinical setting, whereas in the context of clinical studies the main favorable finding consisted in the detection of electrical scar in 4/4 patients undergoing specific evaluation; the minimum dose for efficacy was 25 Gy in both humans and animals. No acute complication was recorded; severe side-effects related to the long-term were observed only for very high STAR doses in 2 animals. Significant variability was evidenced among studies in the definition of target volume and doses, and in the management of respiratory and cardiac target motion. Conclusion STAR is an innovative non-invasive procedure already applied for experimental treatment of ventricular arrhythmias. Particular attention must be paid to safety, rather than efficacy of STAR, given the benign nature of AF. Uncertainties persist, mainly regarding the definition of the treatment plan and the role of the target motion. In this setting, more information about the toxicity profile of this new approach is compulsory before applying STAR to AF in clinical practice.
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Affiliation(s)
- Jessica Franzetti
- Department of Radiation Oncology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Stefania Volpe
- Department of Radiation Oncology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- *Correspondence: Stefania Volpe, , orcid.org/0000-0003-0498-2964
| | - Valentina Catto
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, Milan, Italy
| | - Edoardo Conte
- Cardiovascular Computed Tomography and Radiology Unit, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Consiglia Piccolo
- Unit of Medical Physics, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Matteo Pepa
- Department of Radiation Oncology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Gaia Piperno
- Department of Radiation Oncology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Anna Maria Camarda
- Department of Radiation Oncology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Daniele Andreini
- Cardiovascular Computed Tomography and Radiology Unit, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy
| | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Radiation Oncology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Corrado Carbucicchio
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
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Li H, Dong L, Bert C, Chang J, Flampouri S, Jee KW, Lin L, Moyers M, Mori S, Rottmann J, Tryggestad E, Vedam S. Report of AAPM Task Group 290: Respiratory motion management for particle therapy. Med Phys 2022; 49:e50-e81. [PMID: 35066871 PMCID: PMC9306777 DOI: 10.1002/mp.15470] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 12/28/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022] Open
Abstract
Dose uncertainty induced by respiratory motion remains a major concern for treating thoracic and abdominal lesions using particle beams. This Task Group report reviews the impact of tumor motion and dosimetric considerations in particle radiotherapy, current motion‐management techniques, and limitations for different particle‐beam delivery modes (i.e., passive scattering, uniform scanning, and pencil‐beam scanning). Furthermore, the report provides guidance and risk analysis for quality assurance of the motion‐management procedures to ensure consistency and accuracy, and discusses future development and emerging motion‐management strategies. This report supplements previously published AAPM report TG76, and considers aspects of motion management that are crucial to the accurate and safe delivery of particle‐beam therapy. To that end, this report produces general recommendations for commissioning and facility‐specific dosimetric characterization, motion assessment, treatment planning, active and passive motion‐management techniques, image guidance and related decision‐making, monitoring throughout therapy, and recommendations for vendors. Key among these recommendations are that: (1) facilities should perform thorough planning studies (using retrospective data) and develop standard operating procedures that address all aspects of therapy for any treatment site involving respiratory motion; (2) a risk‐based methodology should be adopted for quality management and ongoing process improvement.
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Affiliation(s)
- Heng Li
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Lei Dong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Christoph Bert
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Joe Chang
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stella Flampouri
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
| | - Kyung-Wook Jee
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Liyong Lin
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
| | - Michael Moyers
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
| | - Shinichiro Mori
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
| | - Joerg Rottmann
- Center for Proton Therapy, Proton Therapy Singapore, Proton Therapy Pte Ltd, Singapore
| | - Erik Tryggestad
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Sastry Vedam
- Department of Radiation Oncology, University of Maryland, Baltimore, USA
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Lee H, Pursley J, Lu HM, Adams J, DeLaney T, Chen YL, Jee KW. A proof of concept treatment planning study of gated proton radiotherapy for cardiac soft tissue sarcoma. Phys Imaging Radiat Oncol 2021; 19:78-84. [PMID: 34368473 PMCID: PMC8326805 DOI: 10.1016/j.phro.2021.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 05/23/2021] [Accepted: 06/03/2021] [Indexed: 12/25/2022] Open
Abstract
Challenges of a cardiac target due to the respiration, the heart motion and the interplay effect. Cardiac respiratory double gating with additional ECG signals for proton radiotherapy. Proton planning study with a cardiac-gated CT scan obtained at the end-expiration.
Background and Purpose Few studies on radiotherapy of cardiac targets exist, and none using a gating method according to cardiac movement. This study aimed to evaluate the dose-volume advantage of using cardiac-respiratory double gating (CRDG) in terms of target location with additional ECG signals in comparison to respiratory single gating (RSG) for proton radiotherapy of targets in the heart. Materials and Methods Cardiac motion was modeled using a cardiac-gated four-dimensional computed tomography scan obtained at the end-expiration. Plans with the prescription dose of 50 Gy (RSG and CRDG plans at diastole and systole phases) were compared in terms of clinically relevant dose-volume criteria for various target sizes and seven cardiac subsites. Potential dose sparing by utilizing CRDG over RSG was quantified in terms of surrounding organ at risk (OAR) doses while the dose coverage to the targets was fully ensured. Results The average mean dose reductions were 28 ± 10% when gated at diastole and 21 ± 12% at systole in heart and 30 ± 17% at diastole and 8 ± 9% at systole in left ventricle compared to respiratory single gating. The diastole phase was optimal for gated treatments for all target locations except right ventricle and interventricular septum. The right ventricle target was best treated at the systole phase. However, an optimal gating phase for the interventricular septum target could not be determined. Conclusions We have studied the dose-volume benefits of CRDG for each cardiac subsite, and demonstrated that CRDG may spare organs at risk better than RSG.
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Affiliation(s)
- Hyeri Lee
- Corresponding author at: Radiation Oncology, Massachusetts General Hospital, 55 Fruit Street, Lunder Building, LL 236, Boston, MA 02114, USA.
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Durante M. Failla Memorial Lecture: The Many Facets of Heavy-Ion Science. Radiat Res 2021; 195:403-411. [PMID: 33979440 DOI: 10.1667/rade-21-00029.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/22/2021] [Indexed: 11/03/2022]
Abstract
Heavy ions are riveting in radiation biophysics, particularly in the areas of radiotherapy and space radiation protection. Accelerated charged particles can indeed penetrate deeply in the human body to sterilize tumors, exploiting the favorable depth-dose distribution of ions compared to conventional X rays. Conversely, the high biological effectiveness in inducing late effects presents a hazard for manned space exploration. Even after half a century of accelerator-based experiments, clinical applications and flight research, these two topics remain both fascinating and baffling. Heavy-ion therapy is very expensive, and despite the clinical success it remains controversial. Research on late radiation morbidity in spaceflight led to a reduction in uncertainty, but also pointed to new risks previously underestimated, such as possible damage to the central nervous system. Recently, heavy ions have also been used in other, unanticipated biomedical fields, such as treatment of heart arrhythmia or inactivation of viruses for vaccine development. Heavy-ion science nicely merges physics and biology and remains an extraordinary research field for the 21st century.
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Affiliation(s)
- Marco Durante
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung, 64291 Darmstadt, Germany; and Technische Universität Darmstadt, Institute of Condensed Matter Physics, 64289 Darmstadt, Germany
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Lydiard, PGDip S, Blanck O, Hugo G, O’Brien R, Keall P. A Review of Cardiac Radioablation (CR) for Arrhythmias: Procedures, Technology, and Future Opportunities. Int J Radiat Oncol Biol Phys 2021; 109:783-800. [DOI: 10.1016/j.ijrobp.2020.10.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/22/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
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Le Bloa M, Abadir S, Nair K, Mondésert B, Khairy P. New developments in catheter ablation for patients with congenital heart disease. Expert Rev Cardiovasc Ther 2020; 19:15-26. [PMID: 33153326 DOI: 10.1080/14779072.2021.1847082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Introduction: There are numerous challenges to catheter ablation in patients with congenital heart disease (CHD), including access to cardiac chambers, distorted anatomies, displaced conduction systems, multiple and/or complex arrhythmia substrates, and excessively thickened walls, or interposed material. Areas covered: Herein, we review recent developments in catheter ablation strategies for patients with CHD that are helpful in addressing these challenges. Expert opinion: Remote magnetic navigation overcomes many challenges associated with vascular obstructions, chamber access, and catheter contact. Patients with CHD may benefit from a range of ablation catheter technologies, including irrigated-tip and contact-force radiofrequency ablation and focal and balloon cryoablation. High-density mapping, along with advances in multipolar catheters and interpolation algorithms, is contributing to new mechanistic insights into complex arrhythmias. Ripple mapping allows the activation wave front to be tracked visually without prior assignment of local activation times or window of interest, and without interpolations of unmapped regions. There is growing interest in measuring conduction velocities to identify arrhythmogenic substrates. Noninvasive mapping with a multielectrode-embedded vest allows prolonged bedside monitoring, which is of particular interest in those with non-sustained or multiple arrhythmias. Further studies are required to assess the role of radiofrequency needle catheters and stereotactic radiotherapy in patients with CHD.
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Affiliation(s)
- Mathieu Le Bloa
- Montreal Heart Institute, Université De Montréal , Montreal, Canada.,Electrophysiology Service, Centre Hospitalier Universitaire Vaudois , Lausanne, Switzerland
| | - Sylvia Abadir
- Montreal Heart Institute, Université De Montréal , Montreal, Canada
| | - Krishnakumar Nair
- University Health Network, Toronto General Hospital , Toronto, Canada
| | | | - Paul Khairy
- Montreal Heart Institute, Université De Montréal , Montreal, Canada
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Widesott L, Dionisi F, Fracchiolla F, Tommasino F, Centonze M, Amichetti M, Del Greco M. Proton or photon radiosurgery for cardiac ablation of ventricular tachycardia? Breath and ECG gated robust optimization. Phys Med 2020; 78:15-31. [PMID: 32911373 DOI: 10.1016/j.ejmp.2020.08.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/20/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Ventricular tachycardia (VT) is a life-threatening heart disorder. The aim of this preliminary study is to assess the feasibility of stereotactic body radiation therapy (SBRT) photon and proton therapy (PT) plans for the treatment of VT, adopting robust optimization technique for both irradiation techniques. METHODS ECG gated CT images (in breath hold) were acquired for one patient. Conventional planning target volume (PTV) and robust optimized plans (25GyE in single fraction) were simulated for both photon (IMRT, 5 and 9 beams) and proton (SFO, 2 beams) plans. Robust optimized plans were obtained both for protons and photons considering in the optimization setup errors (5 mm in the three orthogonal directions), range (±3.5%) and the clinical target volume (CTV) motion due to heartbeat and breath-hold variability. RESULTS The photon robust optimization method, compared to PTV-based plans, showed a reduction in the average dose to the heart by about 25%; robust optimization allowed also reducing the mean dose to the left lung from 3.4. to 2.8 Gy for 9-beams configuration and from 4.1 to 2.9 Gy for 5-beams configuration. Robust optimization with protons, allowed further reducing the OAR doses: average dose to the heart and to the left lung decreased from 7.3 Gy to 5.2 GyE and from 2.9 Gy to 2.2 GyE, respectively. CONCLUSIONS Our study demonstrates the importance of the optimization technique adopted in the treatment planning system for VT treatment. It has been shown that robust optimization can significantly reduce the dose to healthy cardiac tissues and that PT further increases this gain.
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Affiliation(s)
- Lamberto Widesott
- Proton Therapy Department, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy.
| | - Francesco Dionisi
- Proton Therapy Department, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Francesco Fracchiolla
- Proton Therapy Department, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Francesco Tommasino
- Department of Physics, University of Trento, Trento, Italy; Trento Institute for Fundamental Physics and Applications (TIFPA), National Institute of Nuclear Physics (INFN), Trento, Italy
| | - Maurizio Centonze
- Department of Diagnostic Imaging, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Maurizio Amichetti
- Proton Therapy Department, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Maurizio Del Greco
- Department of Cardiac, Santa Maria del Carmine Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Rovereto, Italy
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Scholz M. State-of-the-Art and Future Prospects of Ion Beam Therapy: Physical and Radiobiological Aspects. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2020. [DOI: 10.1109/trpms.2019.2935240] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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11
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Ventricular Tachycardia Ablation. JACC Clin Electrophysiol 2019; 5:1363-1383. [DOI: 10.1016/j.jacep.2019.09.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/23/2019] [Accepted: 09/26/2019] [Indexed: 11/23/2022]
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Biological Cardiac Tissue Effects of High-Energy Heavy Ions - Investigation for Myocardial Ablation. Sci Rep 2019; 9:5000. [PMID: 30899027 PMCID: PMC6428839 DOI: 10.1038/s41598-019-41314-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 02/26/2019] [Indexed: 12/24/2022] Open
Abstract
Noninvasive X-ray stereotactic treatment is considered a promising alternative to catheter ablation in patients affected by severe heart arrhythmia. High-energy heavy ions can deliver high radiation doses in small targets with reduced damage to the normal tissue compared to conventional X-rays. For this reason, charged particle therapy, widely used in oncology, can be a powerful tool for radiosurgery in cardiac diseases. We have recently performed a feasibility study in a swine model using high doses of high-energy C-ions to target specific cardiac structures. Interruption of cardiac conduction was observed in some animals. Here we report the biological effects measured in the pig heart tissue of the same animals six months after the treatment. Immunohistological analysis of the target tissue showed (1.) long-lasting vascular damage, i.e. persistent hemorrhage, loss of microvessels, and occurrence of siderophages, (2.) fibrosis and (3.) loss of polarity of targeted cardiomyocytes and wavy fibers with vacuolization. We conclude that the observed physiological changes in heart function are produced by radiation-induced fibrosis and cardiomyocyte functional inactivation. No effects were observed in the normal tissue traversed by the particle beam, suggesting that charged particles have the potential to produce ablation of specific heart targets with minimal side effects.
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Yu H, Wu W, Chen P, Gong C, Jiang J, Wang S, Liu F, Yu H. Image gradient L 0-norm based PICCS for swinging multi-source CT reconstruction. OPTICS EXPRESS 2019; 27:5264-5279. [PMID: 30876127 PMCID: PMC6410921 DOI: 10.1364/oe.27.005264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/24/2019] [Accepted: 01/29/2019] [Indexed: 06/09/2023]
Abstract
Dynamic computed tomography (CT) is usually employed to image motion objects, such as beating heart, coronary artery and cerebral perfusion, etc. Recently, to further improve the temporal resolution for aperiodic industrial process imaging, the swinging multi-source CT (SMCT) systems and the corresponding swinging multi-source prior image constrained compressed sensing (SM-PICCS) method were developed. Since the SM-PICCS uses the L1-norm of image gradient, the edge structures in the reconstructed images are blurred and motion artifacts are still present. Inspired by the advantages in terms of image edge preservation and fine structure recovering, the L0-norm of image gradient is incorporated into the prior image constrained compressed sensing, leading to an L0-PICCS Algorithm 1Table 1The parameters of L0-PICCS (δ1,δ2,λ1*,λ2*) for numerical simulation.Sourceswδ1(10-2)δ2(10-2)λ1*(10-2)λ2*(10-8)Noise-free510522.001.525522.001.55035002.00471014.33332.00500025522.00500050222.005000Noise51062002.505002554502.501.55054502.901.571027.385.91.5810000258.285.91.5850050522.001.5. The experimental results confirm that the L0-PICCS outperforms the SM-PICCS in both visual inspection and quantitative analysis.
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Affiliation(s)
- Haijun Yu
- Key Lab of Optoelectronic Technology and Systems, Ministry of Education, Chongqing University, Chongqing 400044, China
- Engineering Research Center of Industrial Computed Tomography Nondestructive Testing, Ministry of Education, Chongqing University, Chongqing 400044, China
- College of Mechanical Engineering, Chongqing University, Chongqing 400044, China
- These authors contributed equally to the work
| | - Weiwen Wu
- Key Lab of Optoelectronic Technology and Systems, Ministry of Education, Chongqing University, Chongqing 400044, China
- Engineering Research Center of Industrial Computed Tomography Nondestructive Testing, Ministry of Education, Chongqing University, Chongqing 400044, China
- These authors contributed equally to the work
| | - Peijun Chen
- Key Lab of Optoelectronic Technology and Systems, Ministry of Education, Chongqing University, Chongqing 400044, China
| | - Changcheng Gong
- Key Lab of Optoelectronic Technology and Systems, Ministry of Education, Chongqing University, Chongqing 400044, China
- Engineering Research Center of Industrial Computed Tomography Nondestructive Testing, Ministry of Education, Chongqing University, Chongqing 400044, China
| | - Junru Jiang
- College of Mechanical Engineering, Chongqing University, Chongqing 400044, China
| | - Shaoyu Wang
- Key Lab of Optoelectronic Technology and Systems, Ministry of Education, Chongqing University, Chongqing 400044, China
- Engineering Research Center of Industrial Computed Tomography Nondestructive Testing, Ministry of Education, Chongqing University, Chongqing 400044, China
| | - Fenglin Liu
- Key Lab of Optoelectronic Technology and Systems, Ministry of Education, Chongqing University, Chongqing 400044, China
- Engineering Research Center of Industrial Computed Tomography Nondestructive Testing, Ministry of Education, Chongqing University, Chongqing 400044, China
| | - Hengyong Yu
- Department of Electrical and Computer Engineering, University of Massachusetts Lowell, Lowell, MA 01854, USA
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Bert C, Herfarth K. Management of organ motion in scanned ion beam therapy. Radiat Oncol 2017; 12:170. [PMID: 29110693 PMCID: PMC5674859 DOI: 10.1186/s13014-017-0911-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/27/2017] [Indexed: 12/13/2022] Open
Abstract
Scanned ion beam therapy has special demands for treatment of intra-fractionally moving tumors such as lesions in lung or liver. Interplay effects between beam and organ motion can in those settings lead to under-dosage of the target volume. Dedicated treatment techniques such as gating or abdominal compression are required. In addition 4D treatment planning should be used to determine strategies for patient specific treatment planning such as an increased beam focus or the use of internal target volumes incorporating range changes.Several work packages of the Clinical Research Units 214 and 214/2 funded by the German Research Council investigated the management of organ motion in scanned ion beam therapy. A focus was laid on 4D treatment planning using TRiP4D and the development of motion mitigation strategies including their quality assurance. This review focuses on the activity in the second funding period covering adaptive treatment planning strategies, 4D treatment plan optimization, and the application of motion management in pre-clinical research on radiation therapy of cardiac arrhythmias.
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Affiliation(s)
- Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany.
| | - Klaus Herfarth
- Heidelberg Ion-Beam Therapy Center (HIT) and Department of Radiation Oncology, University Clinic Heidelberg, Heidelberg, Germany
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