Jakob Marshall, Alanah Bergman, Tania Karan, Marc W Deyell, Devin Schellenberg, Steven Thomas
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引用次数: 0
摘要
目的：通过量化立体定向心律失常射频消融术（STAR）中植入的心脏导联或膈肌运动之间的关系，研究它们在主动呼吸运动管理中的效用：在腹部加压（AC）和自由呼吸（FB）条件下，使用 5 赫兹双平面、千伏 X 射线透视对七名接受 STAR 治疗的患者进行了 15-20 秒钟的成像。通过跟踪和三角测量所有植入心脏导联的位置，获取心脏不同区域的三维运动轨迹。使用低通滤波器从总运动（呼吸+心脏）中提取心脏的呼吸运动，并使用主成分分析（PCA）在优化坐标中进行描述。使用斯皮尔曼秩相关系数量化不同心导联或膈肌的呼吸运动之间是否存在关系。建立了 PC1 心导联运动与横膈膜之间的多项式相关模型，并对由此产生的误差进行了评估：在 AC 和 FB 条件下，计算了心脏或膈肌不同位置之间的 81 个呼吸运动相关性。心脏和膈肌不同位置的呼吸运动之间始终保持着很强的相关性，这需要考虑运动之间的相位偏移。在考虑相移的情况下，PC1 呼吸运动强相关性（>0.7）的比例在 FB 条件下为 100%，在 AC 条件下为 92.6%。心导联运动与膈肌的线性拟合导致 PC1 平均绝对跟踪误差在 FB 下为 (1.0 ± 0.6) mm，在 AC 下为 (0.7 ± 0.4) mm：结论：在考虑运动轨迹之间的相位偏移后，所有植入式心脏导联和膈肌组合的呼吸运动都具有中度到高度的相关性。在使用心导管或膈肌作为内部替代物进行 STAR 期间的呼吸跟踪或选通时，应仔细考虑这些相位偏移，以确保患者安全。
Toward the Use of Implanted Cardiac Leads or the Diaphragm for Active Respiratory Motion Management in Stereotactic Arrhythmia Radioablation.
Purpose: To investigate the utility of implanted cardiac leads or the diaphragm for active respiratory motion management in stereotactic arrhythmia radioablation by quantifying the relationship between their motions.
Methods and materials: Seven patients treated with stereotactic arrhythmia radioablation were imaged using 5-Hz biplanar, kV x-ray fluoroscopy for 15-20 seconds under both abdominal compression (AC) and free breathing (FB) conditions. Three-dimensional motion traces for different regions of the heart were acquired by tracking and triangulating the position of all implanted cardiac leads. The heart's respiratory motion was extracted from the total motion (respiratory + cardiac) using a low-pass filter and described in optimized coordinates using principal component analysis. The existence of a relationship between the respiratory motion of different cardiac leads or the diaphragm was quantified using the Spearman rank correlation coefficient. Polynomial correlation models relating PC1 cardiac lead motion to the diaphragm were created and evaluated on the resultant errors.
Results: Eighty-one respiratory motion correlations between different positions of the heart or diaphragm were calculated under both AC and FB. Consistently strong correlations between the respiratory motion of different positions in the heart and the diaphragm required accounting for phase shifts between motions. When accounting for phase shifts, the proportion of strong (>0.7) PC1 respiratory motion correlations was 100% under FB and 92.6% under AC. Linear fitting of cardiac lead motion with the diaphragm resulted in mean absolute PC1 tracking errors of (1.0 ± 0.6) mm under FB and (0.7 ± 0.4) mm under AC.
Conclusions: The respiratory motion of all combinations of implanted cardiac leads and the diaphragm are moderately to strongly correlated after accounting for phase shifts between motion traces. These phase shifts should be carefully considered to ensure patient safety during respiratory tracking or gating during stereotactic arrhythmia radioablation using cardiac leads or the diaphragm as internal surrogates.
期刊介绍：
International Journal of Radiation Oncology • Biology • Physics (IJROBP), known in the field as the Red Journal, publishes original laboratory and clinical investigations related to radiation oncology, radiation biology, medical physics, and both education and health policy as it relates to the field.
This journal has a particular interest in original contributions of the following types: prospective clinical trials, outcomes research, and large database interrogation. In addition, it seeks reports of high-impact innovations in single or combined modality treatment, tumor sensitization, normal tissue protection (including both precision avoidance and pharmacologic means), brachytherapy, particle irradiation, and cancer imaging. Technical advances related to dosimetry and conformal radiation treatment planning are of interest, as are basic science studies investigating tumor physiology and the molecular biology underlying cancer and normal tissue radiation response.
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