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Aquino GJ, Mastrodicasa D, Alabed S, Abohashem S, Wen L, Gill RR, Bardo DME, Abbara S, Hanneman K. Radiology: Cardiothoracic Imaging Highlights 2023. Radiol Cardiothorac Imaging 2024; 6:e240020. [PMID: 38602468 PMCID: PMC11056755 DOI: 10.1148/ryct.240020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/15/2024] [Accepted: 02/28/2024] [Indexed: 04/12/2024]
Abstract
Radiology: Cardiothoracic Imaging publishes novel research and technical developments in cardiac, thoracic, and vascular imaging. The journal published many innovative studies during 2023 and achieved an impact factor for the first time since its inaugural issue in 2019, with an impact factor of 7.0. The current review article, led by the Radiology: Cardiothoracic Imaging trainee editorial board, highlights the most impactful articles published in the journal between November 2022 and October 2023. The review encompasses various aspects of coronary CT, photon-counting detector CT, PET/MRI, cardiac MRI, congenital heart disease, vascular imaging, thoracic imaging, artificial intelligence, and health services research. Key highlights include the potential for photon-counting detector CT to reduce contrast media volumes, utility of combined PET/MRI in the evaluation of cardiac sarcoidosis, the prognostic value of left atrial late gadolinium enhancement at MRI in predicting incident atrial fibrillation, the utility of an artificial intelligence tool to optimize detection of incidental pulmonary embolism, and standardization of medical terminology for cardiac CT. Ongoing research and future directions include evaluation of novel PET tracers for assessment of myocardial fibrosis, deployment of AI tools in clinical cardiovascular imaging workflows, and growing awareness of the need to improve environmental sustainability in imaging. Keywords: Coronary CT, Photon-counting Detector CT, PET/MRI, Cardiac MRI, Congenital Heart Disease, Vascular Imaging, Thoracic Imaging, Artificial Intelligence, Health Services Research © RSNA, 2024.
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Affiliation(s)
| | | | - Samer Alabed
- From the Department of Radiology, SUNY Upstate Medical University,
750 E Adams St, Syracuse, NY, 13210 (G.J.A); Department of Radiology, University
of Washington School of Medicine, UW Medical Center Montlake, Seattle, Wash
(D.M.); Department of Radiology, OncoRad/Tumor Imaging Metrics Core (TIMC),
University of Washington School of Medicine, Seattle, Wash (D.M.); Division of
Clinical Medicine, School of Medicine and Population Health, University of
Sheffield, Sheffield, United Kingdom (S. Alabed); National Institute for Health
and Care Research, Sheffield Biomedical Research Centre, Sheffield, United
Kingdom (S. Alabed); Department of Radiology, Cardiovascular Imaging Research
Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
(S. Abohashem); Department of Radiology, Key Laboratory of Birth Defects and
Related Diseases of Women and Children, Ministry of Education, West China Second
University Hospital, Sichuan University, Sichuan, China (L.W.); Department of
Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston,
Mass (R.R.G.); Department of Medical Imaging, Ann & Robert H. Lurie
Children’s Hospital of Chicago, Chicago, Ill (D.M.E.B.); Department of
Radiology, UT Southwestern Medical Center, Dallas, Tex (S. Abbara); Department
of Medical Imaging, University Medical Imaging Toronto, University of Toronto,
Toronto, Ontario, Canada (K.H.); and Peter Munk Cardiac Centre, Toronto General
Hospital, University of Toronto, Toronto, Ontario, Canada (K.H.)
| | - Shady Abohashem
- From the Department of Radiology, SUNY Upstate Medical University,
750 E Adams St, Syracuse, NY, 13210 (G.J.A); Department of Radiology, University
of Washington School of Medicine, UW Medical Center Montlake, Seattle, Wash
(D.M.); Department of Radiology, OncoRad/Tumor Imaging Metrics Core (TIMC),
University of Washington School of Medicine, Seattle, Wash (D.M.); Division of
Clinical Medicine, School of Medicine and Population Health, University of
Sheffield, Sheffield, United Kingdom (S. Alabed); National Institute for Health
and Care Research, Sheffield Biomedical Research Centre, Sheffield, United
Kingdom (S. Alabed); Department of Radiology, Cardiovascular Imaging Research
Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
(S. Abohashem); Department of Radiology, Key Laboratory of Birth Defects and
Related Diseases of Women and Children, Ministry of Education, West China Second
University Hospital, Sichuan University, Sichuan, China (L.W.); Department of
Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston,
Mass (R.R.G.); Department of Medical Imaging, Ann & Robert H. Lurie
Children’s Hospital of Chicago, Chicago, Ill (D.M.E.B.); Department of
Radiology, UT Southwestern Medical Center, Dallas, Tex (S. Abbara); Department
of Medical Imaging, University Medical Imaging Toronto, University of Toronto,
Toronto, Ontario, Canada (K.H.); and Peter Munk Cardiac Centre, Toronto General
Hospital, University of Toronto, Toronto, Ontario, Canada (K.H.)
| | - Lingyi Wen
- From the Department of Radiology, SUNY Upstate Medical University,
750 E Adams St, Syracuse, NY, 13210 (G.J.A); Department of Radiology, University
of Washington School of Medicine, UW Medical Center Montlake, Seattle, Wash
(D.M.); Department of Radiology, OncoRad/Tumor Imaging Metrics Core (TIMC),
University of Washington School of Medicine, Seattle, Wash (D.M.); Division of
Clinical Medicine, School of Medicine and Population Health, University of
Sheffield, Sheffield, United Kingdom (S. Alabed); National Institute for Health
and Care Research, Sheffield Biomedical Research Centre, Sheffield, United
Kingdom (S. Alabed); Department of Radiology, Cardiovascular Imaging Research
Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
(S. Abohashem); Department of Radiology, Key Laboratory of Birth Defects and
Related Diseases of Women and Children, Ministry of Education, West China Second
University Hospital, Sichuan University, Sichuan, China (L.W.); Department of
Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston,
Mass (R.R.G.); Department of Medical Imaging, Ann & Robert H. Lurie
Children’s Hospital of Chicago, Chicago, Ill (D.M.E.B.); Department of
Radiology, UT Southwestern Medical Center, Dallas, Tex (S. Abbara); Department
of Medical Imaging, University Medical Imaging Toronto, University of Toronto,
Toronto, Ontario, Canada (K.H.); and Peter Munk Cardiac Centre, Toronto General
Hospital, University of Toronto, Toronto, Ontario, Canada (K.H.)
| | - Ritu R. Gill
- From the Department of Radiology, SUNY Upstate Medical University,
750 E Adams St, Syracuse, NY, 13210 (G.J.A); Department of Radiology, University
of Washington School of Medicine, UW Medical Center Montlake, Seattle, Wash
(D.M.); Department of Radiology, OncoRad/Tumor Imaging Metrics Core (TIMC),
University of Washington School of Medicine, Seattle, Wash (D.M.); Division of
Clinical Medicine, School of Medicine and Population Health, University of
Sheffield, Sheffield, United Kingdom (S. Alabed); National Institute for Health
and Care Research, Sheffield Biomedical Research Centre, Sheffield, United
Kingdom (S. Alabed); Department of Radiology, Cardiovascular Imaging Research
Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
(S. Abohashem); Department of Radiology, Key Laboratory of Birth Defects and
Related Diseases of Women and Children, Ministry of Education, West China Second
University Hospital, Sichuan University, Sichuan, China (L.W.); Department of
Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston,
Mass (R.R.G.); Department of Medical Imaging, Ann & Robert H. Lurie
Children’s Hospital of Chicago, Chicago, Ill (D.M.E.B.); Department of
Radiology, UT Southwestern Medical Center, Dallas, Tex (S. Abbara); Department
of Medical Imaging, University Medical Imaging Toronto, University of Toronto,
Toronto, Ontario, Canada (K.H.); and Peter Munk Cardiac Centre, Toronto General
Hospital, University of Toronto, Toronto, Ontario, Canada (K.H.)
| | - Dianna M. E. Bardo
- From the Department of Radiology, SUNY Upstate Medical University,
750 E Adams St, Syracuse, NY, 13210 (G.J.A); Department of Radiology, University
of Washington School of Medicine, UW Medical Center Montlake, Seattle, Wash
(D.M.); Department of Radiology, OncoRad/Tumor Imaging Metrics Core (TIMC),
University of Washington School of Medicine, Seattle, Wash (D.M.); Division of
Clinical Medicine, School of Medicine and Population Health, University of
Sheffield, Sheffield, United Kingdom (S. Alabed); National Institute for Health
and Care Research, Sheffield Biomedical Research Centre, Sheffield, United
Kingdom (S. Alabed); Department of Radiology, Cardiovascular Imaging Research
Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
(S. Abohashem); Department of Radiology, Key Laboratory of Birth Defects and
Related Diseases of Women and Children, Ministry of Education, West China Second
University Hospital, Sichuan University, Sichuan, China (L.W.); Department of
Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston,
Mass (R.R.G.); Department of Medical Imaging, Ann & Robert H. Lurie
Children’s Hospital of Chicago, Chicago, Ill (D.M.E.B.); Department of
Radiology, UT Southwestern Medical Center, Dallas, Tex (S. Abbara); Department
of Medical Imaging, University Medical Imaging Toronto, University of Toronto,
Toronto, Ontario, Canada (K.H.); and Peter Munk Cardiac Centre, Toronto General
Hospital, University of Toronto, Toronto, Ontario, Canada (K.H.)
| | - Suhny Abbara
- From the Department of Radiology, SUNY Upstate Medical University,
750 E Adams St, Syracuse, NY, 13210 (G.J.A); Department of Radiology, University
of Washington School of Medicine, UW Medical Center Montlake, Seattle, Wash
(D.M.); Department of Radiology, OncoRad/Tumor Imaging Metrics Core (TIMC),
University of Washington School of Medicine, Seattle, Wash (D.M.); Division of
Clinical Medicine, School of Medicine and Population Health, University of
Sheffield, Sheffield, United Kingdom (S. Alabed); National Institute for Health
and Care Research, Sheffield Biomedical Research Centre, Sheffield, United
Kingdom (S. Alabed); Department of Radiology, Cardiovascular Imaging Research
Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
(S. Abohashem); Department of Radiology, Key Laboratory of Birth Defects and
Related Diseases of Women and Children, Ministry of Education, West China Second
University Hospital, Sichuan University, Sichuan, China (L.W.); Department of
Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston,
Mass (R.R.G.); Department of Medical Imaging, Ann & Robert H. Lurie
Children’s Hospital of Chicago, Chicago, Ill (D.M.E.B.); Department of
Radiology, UT Southwestern Medical Center, Dallas, Tex (S. Abbara); Department
of Medical Imaging, University Medical Imaging Toronto, University of Toronto,
Toronto, Ontario, Canada (K.H.); and Peter Munk Cardiac Centre, Toronto General
Hospital, University of Toronto, Toronto, Ontario, Canada (K.H.)
| | - Kate Hanneman
- From the Department of Radiology, SUNY Upstate Medical University,
750 E Adams St, Syracuse, NY, 13210 (G.J.A); Department of Radiology, University
of Washington School of Medicine, UW Medical Center Montlake, Seattle, Wash
(D.M.); Department of Radiology, OncoRad/Tumor Imaging Metrics Core (TIMC),
University of Washington School of Medicine, Seattle, Wash (D.M.); Division of
Clinical Medicine, School of Medicine and Population Health, University of
Sheffield, Sheffield, United Kingdom (S. Alabed); National Institute for Health
and Care Research, Sheffield Biomedical Research Centre, Sheffield, United
Kingdom (S. Alabed); Department of Radiology, Cardiovascular Imaging Research
Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
(S. Abohashem); Department of Radiology, Key Laboratory of Birth Defects and
Related Diseases of Women and Children, Ministry of Education, West China Second
University Hospital, Sichuan University, Sichuan, China (L.W.); Department of
Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston,
Mass (R.R.G.); Department of Medical Imaging, Ann & Robert H. Lurie
Children’s Hospital of Chicago, Chicago, Ill (D.M.E.B.); Department of
Radiology, UT Southwestern Medical Center, Dallas, Tex (S. Abbara); Department
of Medical Imaging, University Medical Imaging Toronto, University of Toronto,
Toronto, Ontario, Canada (K.H.); and Peter Munk Cardiac Centre, Toronto General
Hospital, University of Toronto, Toronto, Ontario, Canada (K.H.)
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Akdag O, Borman PTS, Mandija S, Woodhead PL, Uijtewaal P, Raaymakers BW, Fast MF. Experimental demonstration of real-time cardiac physiology-based radiotherapy gating for improved cardiac radioablation on an MR-linac. Med Phys 2024; 51:2354-2366. [PMID: 38477841 DOI: 10.1002/mp.17024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/09/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Cardiac radioablation is a noninvasive stereotactic body radiation therapy (SBRT) technique to treat patients with refractory ventricular tachycardia (VT) by delivering a single high-dose fraction to the VT isthmus. Cardiorespiratory motion induces position uncertainties resulting in decreased dose conformality. Electocardiograms (ECG) are typically used during cardiac MRI (CMR) to acquire images in a predefined cardiac phase, thus mitigating cardiac motion during image acquisition. PURPOSE We demonstrate real-time cardiac physiology-based radiotherapy beam gating within a preset cardiac phase on an MR-linac. METHODS MR images were acquired in healthy volunteers (n = 5, mean age = 29.6 years, mean heart-rate (HR) = 56.2 bpm) on the 1.5 T Unity MR-linac (Elekta AB, Stockholm, Sweden) after obtaining written informed consent. The images were acquired using a single-slice balance steady-state free precession (bSSFP) sequence in the coronal or sagittal plane (TR/TE = 3/1.48 ms, flip angle = 48∘ $^{\circ }$ , SENSE = 1.5,field-of-view = 400 × 207 $\text{field-of-view} = {400}\times {207}$ mm 2 ${\text{mm}}^{2}$ , voxel size =3 × 3 × 15 $3\times 3\times 15$ mm 3 ${\rm mm}^{3}$ , partial Fourier factor = 0.65, frame rate = 13.3 Hz). In parallel, a 4-lead ECG-signal was acquired using MR-compatible equipment. The feasibility of ECG-based beam gating was demonstrated with a prototype gating workflow using a Quasar MRI4D motion phantom (IBA Quasar, London, ON, Canada), which was deployed in the bore of the MR-linac. Two volunteer-derived combined ECG-motion traces (n = 2, mean age = 26 years, mean HR = 57.4 bpm, peak-to-peak amplitude = 14.7 mm) were programmed into the phantom to mimic dose delivery on a cardiac target in breath-hold. Clinical ECG-equipment was connected to the phantom for ECG-voltage-streaming in real-time using research software. Treatment beam gating was performed in the quiescent phase (end-diastole). System latencies were compensated by delay time correction. A previously developed MRI-based gating workflow was used as a benchmark in this study. A 15-beam intensity-modulated radiotherapy (IMRT) plan (1 × 6.25 ${1}\times {6.25}$ Gy) was delivered for different motion scenarios onto radiochromic films. Next, cardiac motion was then estimated at the basal anterolateral myocardial wall via normalized cross-correlation-based template matching. The estimated motion signal was temporally aligned with the ECG-signal, which were then used for position- and ECG-based gating simulations in the cranial-caudal (CC), anterior-posterior (AP), and right-left (RL) directions. The effect of gating was investigated by analyzing the differences in residual motion at 30, 50, and 70% treatment beam duty cycles. RESULTS ECG-based (MRI-based) beam gating was performed with effective duty cycles of 60.5% (68.8%) and 47.7% (50.4%) with residual motion reductions of 62.5% (44.7%) and 43.9% (59.3%). Local gamma analyses (1%/1 mm) returned pass rates of 97.6% (94.1%) and 90.5% (98.3%) for gated scenarios, which exceed the pass rates of 70.3% and 82.0% for nongated scenarios, respectively. In average, the gating simulations returned maximum residual motion reductions of 88%, 74%, and 81% at 30%, 50%, and 70% duty cycles, respectively, in favor of MRI-based gating. CONCLUSIONS Real-time ECG-based beam gating is a feasible alternative to MRI-based gating, resulting in improved dose delivery in terms of highγ -pass $\gamma {\text{-pass}}$ rates, decreased dose deposition outside the PTV and residual motion reduction, while by-passing cardiac MRI challenges.
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Affiliation(s)
- Osman Akdag
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pim T S Borman
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefano Mandija
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
- Computational Imaging Group for MR Diagnostics and Therapy, Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter L Woodhead
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
- Elekta AB, Stockholm, Sweden
| | - Prescilla Uijtewaal
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bas W Raaymakers
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martin F Fast
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
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