ECG-based 4D-dose reconstruction of cardiac arrhythmia ablation with carbon ion beams: application in a porcine model

Richter D, Lehmann HI, Eichhorn A, Constantinescu AM, Kaderka R, Prall M, Lugenbiel P, Takami M, Thomas D, Bert C, Durante M, Packer DL, Graeff C (2017)

Publication Type: Journal article

Publication year: 2017

Journal

Physics in Medicine and Biology IOP Publishing

Book Volume: 62

Pages Range: 6869-6883

Journal Issue: 17

DOI: 10.1088/1361-6560/aa7b67

Abstract

Noninvasive ablation of cardiac arrhythmia by scanned particle radiotherapy is highly promising, but especially challenging due to cardiac and respiratory motion. Irradiations for catheter-free ablation in intact pigs were carried out at the GSI Helmholtz Center in Darmstadt using scanned carbon ions. Here, we present real-time electrocardiogram (ECG) data to estimate time-resolved (4D) delivered dose. For 11 animals, surface ECGs and temporal structure of beam delivery were acquired during irradiation. R waves were automatically detected from surface ECGs. Pre-treatment ECG-triggered 4D-CT phases were synchronized to the R-R interval. 4D-dose calculation was performed using GSI's in-house 4D treatment planning system. Resulting dose distributions were assessed with respect to coverage (D95 and V95), heterogeneity (HI  =  D5-D95) and normal tissue exposure. Final results shown here were performed offline, but first calculations were started shortly after irradiation The D95 for TV and PTV was above 95% for 10 and 8 out of 11 animals, respectively. HI was reduced for PTV versus TV volumes, especially for some of the animals targeted at the atrioventricular junction, indicating residual interplay effects due to cardiac motion. Risk structure exposure was comparable to static and 4D treatment planning simulations. ECG-based 4D-dose reconstruction is technically feasible in a patient treatment-like setting. Further development of the presented approach, such as real-time dose calculation, may contribute to safe, successful treatments using scanned ion beams for cardiac arrhythmia ablation.

Authors with CRIS profile

Christoph Bert Professur für Med. Strahlenphysik

Involved external institutions

GSI Helmholtzzentrum für Schwerionenforschung GmbH DE Germany (DE) Saint Mary's Hospital US United States (USA) (US) Universitätsklinikum Heidelberg DE Germany (DE)

How to cite

APA:

Richter, D., Lehmann, H.I., Eichhorn, A., Constantinescu, A.M., Kaderka, R., Prall, M.,... Graeff, C. (2017). ECG-based 4D-dose reconstruction of cardiac arrhythmia ablation with carbon ion beams: application in a porcine model. Physics in Medicine and Biology, 62(17), 6869-6883. https://dx.doi.org/10.1088/1361-6560/aa7b67

MLA:

Richter, Daniel, et al. "ECG-based 4D-dose reconstruction of cardiac arrhythmia ablation with carbon ion beams: application in a porcine model." Physics in Medicine and Biology 62.17 (2017): 6869-6883.

BibTeX: Download