Adèle Gabillaud, Louis Rigal, Raphaël Martins, Renaud De Crevoisier, Juan Cisneros, Loïg Duvergé, Mathieu Lederlin, Nolwenn Delaby, Karim Benali, Antoine Simon, Julien Bellec
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For each patient, a cardiac-gated four-dimensional computed tomography (4D-CT<sub>card</sub>) scan and a respiratory-gated four-dimensional computed tomography (4D-CT<sub>resp)</sub> were acquired. All patients were treated using a volumetric modulated arc therapy technique using an in-treatment Cone-Beam CT (CBCT) image guidance. The MidP approach was implemented to compensate for uncertainties, including cardio-respiratory motions characterized using the 4D-CT<sub>card</sub> and 4D-CT<sub>resp</sub> scans, and the inter-fraction motions measured using the CBCT scans. For comparison purposes, the ITV approach was also implemented. Both approaches were compared in terms of planning target volume (PTV) volumes, doses to organs-at-risk, and clinical target volume (CTV) doses, assessed using a 4D modeling method that estimates the accumulated dose.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Compared with the ITV method, the MidP approach resulted in a mean [min-max] relative PTV volume reduction of 30% [19%, 48%] (<i>p</i> < 0.001, Wilcoxon signed rank test). The mean [min-max] D95% CTV coverage was 105% [101%–114%] and 107% [101%–117%] of the prescription dose for MidP and ITV-based plans, respectively. The median dose to the whole heart was significantly lower with MidP-based plans with a mean difference of −0.5 Gy (<i>p</i> = 0.0084). The near-maximum dose (D1%) delivered to left coronary arteries, aorta, and stomach was systematically lower with the MidP-based plans.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Compared to ITV based approach, the use of MidP strategy for treatment planning of STAR leads to significantly smaller PTV and lower surrounding OAR doses while still achieving a clinically acceptable CTV coverage.</p>\n </section>\n </div>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"26 7","pages":""},"PeriodicalIF":2.2000,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acm2.70170","citationCount":"0","resultStr":"{\"title\":\"Optimizing cardio-respiratory motion management in stereotactic arrhythmia radioablation through mid-position planning target volume\",\"authors\":\"Adèle Gabillaud, Louis Rigal, Raphaël Martins, Renaud De Crevoisier, Juan Cisneros, Loïg Duvergé, Mathieu Lederlin, Nolwenn Delaby, Karim Benali, Antoine Simon, Julien Bellec\",\"doi\":\"10.1002/acm2.70170\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Purpose/objective</h3>\\n \\n <p>This study proposes an implementation of the mid-position (MidP) approach to compensate for cardio-respiratory motions in the context of Stereotactic Arrhythmia Radioablation (STAR) and evaluates its benefits compared to an internal target volume (ITV) approach.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Materials and methods</h3>\\n \\n <p>Fifteen patients who underwent STAR for refractory ventricular tachycardia in our institution were included in this retrospective planning study. For each patient, a cardiac-gated four-dimensional computed tomography (4D-CT<sub>card</sub>) scan and a respiratory-gated four-dimensional computed tomography (4D-CT<sub>resp)</sub> were acquired. All patients were treated using a volumetric modulated arc therapy technique using an in-treatment Cone-Beam CT (CBCT) image guidance. The MidP approach was implemented to compensate for uncertainties, including cardio-respiratory motions characterized using the 4D-CT<sub>card</sub> and 4D-CT<sub>resp</sub> scans, and the inter-fraction motions measured using the CBCT scans. For comparison purposes, the ITV approach was also implemented. 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Optimizing cardio-respiratory motion management in stereotactic arrhythmia radioablation through mid-position planning target volume
Purpose/objective
This study proposes an implementation of the mid-position (MidP) approach to compensate for cardio-respiratory motions in the context of Stereotactic Arrhythmia Radioablation (STAR) and evaluates its benefits compared to an internal target volume (ITV) approach.
Materials and methods
Fifteen patients who underwent STAR for refractory ventricular tachycardia in our institution were included in this retrospective planning study. For each patient, a cardiac-gated four-dimensional computed tomography (4D-CTcard) scan and a respiratory-gated four-dimensional computed tomography (4D-CTresp) were acquired. All patients were treated using a volumetric modulated arc therapy technique using an in-treatment Cone-Beam CT (CBCT) image guidance. The MidP approach was implemented to compensate for uncertainties, including cardio-respiratory motions characterized using the 4D-CTcard and 4D-CTresp scans, and the inter-fraction motions measured using the CBCT scans. For comparison purposes, the ITV approach was also implemented. Both approaches were compared in terms of planning target volume (PTV) volumes, doses to organs-at-risk, and clinical target volume (CTV) doses, assessed using a 4D modeling method that estimates the accumulated dose.
Results
Compared with the ITV method, the MidP approach resulted in a mean [min-max] relative PTV volume reduction of 30% [19%, 48%] (p < 0.001, Wilcoxon signed rank test). The mean [min-max] D95% CTV coverage was 105% [101%–114%] and 107% [101%–117%] of the prescription dose for MidP and ITV-based plans, respectively. The median dose to the whole heart was significantly lower with MidP-based plans with a mean difference of −0.5 Gy (p = 0.0084). The near-maximum dose (D1%) delivered to left coronary arteries, aorta, and stomach was systematically lower with the MidP-based plans.
Conclusion
Compared to ITV based approach, the use of MidP strategy for treatment planning of STAR leads to significantly smaller PTV and lower surrounding OAR doses while still achieving a clinically acceptable CTV coverage.
期刊介绍：
Journal of Applied Clinical Medical Physics is an international Open Access publication dedicated to clinical medical physics. JACMP welcomes original contributions dealing with all aspects of medical physics from scientists working in the clinical medical physics around the world. JACMP accepts only online submission.
JACMP will publish:
-Original Contributions: Peer-reviewed, investigations that represent new and significant contributions to the field. Recommended word count: up to 7500.
-Review Articles: Reviews of major areas or sub-areas in the field of clinical medical physics. These articles may be of any length and are peer reviewed.
-Technical Notes: These should be no longer than 3000 words, including key references.
-Letters to the Editor: Comments on papers published in JACMP or on any other matters of interest to clinical medical physics. These should not be more than 1250 (including the literature) and their publication is only based on the decision of the editor, who occasionally asks experts on the merit of the contents.
-Book Reviews: The editorial office solicits Book Reviews.
-Announcements of Forthcoming Meetings: The Editor may provide notice of forthcoming meetings, course offerings, and other events relevant to clinical medical physics.
-Parallel Opposed Editorial: We welcome topics relevant to clinical practice and medical physics profession. The contents can be controversial debate or opposed aspects of an issue. One author argues for the position and the other against. Each side of the debate contains an opening statement up to 800 words, followed by a rebuttal up to 500 words. Readers interested in participating in this series should contact the moderator with a proposed title and a short description of the topic
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