PMID- 35586650
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220716
IS  - 2297-055X (Print)
IS  - 2297-055X (Electronic)
IS  - 2297-055X (Linking)
VI  - 9
DP  - 2022
TI  - Stereotactic Ablative Radiotherapy of Ventricular Tachycardia Using Tracking: 
      Optimized Target Definition Workflow.
PG  - 870127
LID - 10.3389/fcvm.2022.870127 [doi]
LID - 870127
AB  - BACKGROUND AND PURPOSE: Stereotactic arrhythmia radioablation (STAR) has been 
      suggested as a promising therapeutic alternative in cases of failed catheter 
      ablation for recurrent ventricular tachycardias in patients with structural heart 
      disease. Cyberknife((R)) robotic radiosurgery system utilizing target tracking 
      technology is one of the available STAR treatment platforms. Tracking using 
      implantable cardioverter-defibrillator lead tip as target surrogate marker is 
      affected by the deformation of marker-target geometry. A simple method to account 
      for the deformation in the target definition process is proposed. METHODS: 
      Radiotherapy planning CT series include scans at expiration and inspiration 
      breath hold, and three free-breathing scans. All secondary series are triple 
      registered to the primary CT: 6D/spine + 3D translation/marker + 3D 
      translation/target surrogate-a heterogeneous structure around the left main 
      coronary artery. The 3D translation difference between the last two registrations 
      reflects the deformation between the marker and the target (surrogate) for the 
      respective respiratory phase. Maximum translation differences in each direction 
      form an anisotropic geometry deformation margin (GDM) to expand the initial 
      single-phase clinical target volume (CTV) to create an internal target volume 
      (ITV) in the dynamic coordinates of the marker. Alternative GDM-based target 
      volumes were created for seven recent STAR patients and compared to the original 
      treated planning target volumes (PTVs) as well as to analogical volumes created 
      using deformable image registration (DIR) by MIM((R)) and Velocity((R)) software. 
      Intra- and inter-observer variabilities of the triple registration process were 
      tested as components of the final ITV to PTV margin. RESULTS: A margin of 2 mm 
      has been found to cover the image registration observer variability. GDM-based 
      target volumes are larger and shifted toward the inspiration phase relative to 
      the original clinical volumes based on a 3-mm isotropic margin without 
      deformation consideration. GDM-based targets are similar (mean DICE similarity 
      coefficient range 0.80-0.87) to their equivalents based on the DIR of the primary 
      target volume delineated by dedicated software. CONCLUSION: The proposed GDM 
      method is a simple way to account for marker-target deformation-related 
      uncertainty for tracking with Cyberknife((R)) and better control of the risk of 
      target underdose. The principle applies to general radiotherapy as well.
CI  - Copyright (c) 2022 Dvorak, Knybel, Dudas, Benyskova and Cvek.
FAU - Dvorak, Pavel
AU  - Dvorak P
AD  - Department of Oncology, University Hospital Ostrava, Ostrava, Czechia.
AD  - Department of Radiation Protection, General University Hospital Prague, Praha, 
      Czechia.
FAU - Knybel, Lukas
AU  - Knybel L
AD  - Department of Oncology, University Hospital Ostrava, Ostrava, Czechia.
FAU - Dudas, Denis
AU  - Dudas D
AD  - Department of Oncology, University Hospital Motol, Praha, Czechia.
FAU - Benyskova, Pavla
AU  - Benyskova P
AD  - Department of Oncology, University Hospital Ostrava, Ostrava, Czechia.
FAU - Cvek, Jakub
AU  - Cvek J
AD  - Department of Oncology, University Hospital Ostrava, Ostrava, Czechia.
AD  - Faculty of Medicine, University Hospital Ostrava, Ostrava, Czechia.
LA  - eng
PT  - Journal Article
DEP - 20220502
PL  - Switzerland
TA  - Front Cardiovasc Med
JT  - Frontiers in cardiovascular medicine
JID - 101653388
PMC - PMC9108236
OTO - NOTNLM
OT  - Cyberknife
OT  - deformation
OT  - motion management
OT  - radiotherapy
OT  - stereotactic
OT  - target definition
OT  - tracking
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2022/05/20 06:00
MHDA- 2022/05/20 06:01
PMCR- 2022/01/01
CRDT- 2022/05/19 02:28
PHST- 2022/02/05 00:00 [received]
PHST- 2022/03/28 00:00 [accepted]
PHST- 2022/05/19 02:28 [entrez]
PHST- 2022/05/20 06:00 [pubmed]
PHST- 2022/05/20 06:01 [medline]
PHST- 2022/01/01 00:00 [pmc-release]
AID - 10.3389/fcvm.2022.870127 [doi]
PST - epublish
SO  - Front Cardiovasc Med. 2022 May 2;9:870127. doi: 10.3389/fcvm.2022.870127. 
      eCollection 2022.