A Review of Cardiac Radioablation (CR) for Arrhythmias: Procedures, Technology, and Future Opportunities

Lydiard, PGDip Suzanne; Blanck, Oliver; Hugo, Geoffrey D.; O’Brien, Ricky; Keall, P.

doi:10.1016/j.ijrobp.2020.10.036

Cited by 49 publications

(34 citation statements)

References 80 publications

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“…In addition, a precise gating or tracking could be done without the need and limitations of a fiducial marker. This could further reduce the safety margins to be applied and perhaps reduce treatment times, particularly in case of respiratory gated delivery for radiotherapy with heavy particles such as protons and carbon ions ( 9 , 10 , 12 , 20 ). A further usefulness of this system could consist in increasing the safety in the treatment phase, by controlling in real time the cardiac cycle and heart movements and allowing to interrupt the delivery of the radiant beam in case of anomalies on each of these two factors with extremely short reaction times.…”

Section: Discussionmentioning

confidence: 99%

“…The need for target's movement management is of the utmost importance particularly in case of respiratory gated delivery for radiotherapy with heavy particles such as protons and carbon ions ( 9 , 10 ). At present, the strategies applied for cardio-respiratory movements compensation are limited by the need to consistently increase the size of the treated volume (e.g., internal target volume generated by 4D cardiac or respiratory CT or both), extend treatment time (e.g., gated delivery), and globally by the unsolved need to directly monitor cardio-respiratory movements in real-time without the use of fiducial markers ( 6 , 8 , 11 , 12 ). A possible solution to this issue could be represented by the use of echocardiography as a fully non-invasive tool for monitoring internal motion.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of an Automatic Ultrasonographic Image Acquisition System Associated With an Artificial Intelligence Algorithm for Real-Time Monitoring of Cardiac Motion During Cardiac Radio-Ablation

Casula

Dusi

Camps³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThe management of the cardio-respiratory motion of the target and the reduction of the uncertainties related to patient's positioning are two of the main challenges that stereotactic arrhythmia radio-ablation (STAR) has to overcome. A prototype of a system was developed that can automatically acquire and interpret echocardiographic images using an artificial intelligence (AI) algorithm to calculate cardiac displacement in real-time.MethodsWe conducted a single center study enrolling consecutive patients with a history of ventricular arrhythmias (VA) in order to evaluate the feasibility of this automatic acquisition system. Echocardiographic images were automatically acquired from the parasternal and apical views with a dedicated probe. The system was designed to hold the probe fixed to the chest in the supine position during both free-breathing and short expiratory breath-hold sequences, to simulate STAR treatment. The primary endpoint was the percentage of patients reaching a score ≥2 in a multi-parametric assessment evaluating the quality of automatically acquired images. Moreover, we investigated the potential impact of clinical and demographic characteristics on achieving the primary endpoint.ResultsWe enrolled 24 patients (63 ± 14 years, 21% females). All of them had a history of VA and 21 (88%) had an ICD. Eight patients (33%) had coronary artery disease, 12 (50%) had non-ischemic cardiomyopathy, and 3 had idiopathic VA. Parasternal, as well as apical images were obtained from all patients except from one, in whom parasternal view could not be collected due to the patient's inability to maintain the supine position. The primary endpoint was achieved in 23 patients (96%) for the apical view, in 20 patients (87%) for the parasternal view, and in all patients in at least one of the two views. The images' quality was maximal (i.e., score = 4) in at least one of the two windows in 19 patients (79%). Atrial fibrillation arrhythmia was the only clinical characteristics associated with a poor score outcome in both imaging windows (apical p = 0.022, parasternal p = 0.014).ConclusionsThese results provide the proof-of-concept for the feasibility of an automatic ultrasonographic image acquisition system associated with an AI algorithm for real-time monitoring of cardiac motion in patients with a history of VA.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Feasibility of an Automatic Ultrasonographic Image Acquisition System Associated With an Artificial Intelligence Algorithm for Real-Time Monitoring of Cardiac Motion During Cardiac Radio-Ablation

Casula

Dusi

Camps³

et al. 2022

Front. Cardiovasc. Med.

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“… 11–13 Radiotherapy treatment delivery is another challenge in the case of STAR treatments because of respiratory and cardiac motion of the target area. 13 Furthermore, the indication for STAR treatment is often given at a short notice due to incessant VT or electrical storm.…”

Section: Introductionmentioning

confidence: 99%

STereotactic Arrhythmia Radioablation (STAR): the Standardized Treatment and Outcome Platform for Stereotactic Therapy Of Re-entrant tachycardia by a Multidisciplinary consortium (STOPSTORM.eu) and review of current patterns of STAR practice in Europe

et al. 2023

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The EU Horizon 2020 Framework-funded Standardized Treatment and Outcome Platform for Stereotactic Therapy Of Re-entrant tachycardia by a Multidisciplinary (STOPSTORM) consortium has been established as a large research network for investigating STereotactic Arrhythmia Radioablation (STAR) for ventricular tachycardia (VT). The aim is to provide a pooled treatment database to evaluate patterns of practice and outcomes of STAR and finally to harmonize STAR within Europe. The consortium comprises 31 clinical and research institutions. The project is divided into nine work packages (WPs): (i) observational cohort; (ii) standardization and harmonization of target delineation; (iii) harmonized prospective cohort; (iv) quality assurance (QA); (v) analysis and evaluation; (vi, ix) ethics and regulations; and (vii, viii) project coordination and dissemination. To provide a review of current clinical STAR practice in Europe, a comprehensive questionnaire was performed at project start. The STOPSTORM Institutions’ experience in VT catheter ablation (83% ≥ 20 ann.) and stereotactic body radiotherapy (59% > 200 ann.) was adequate, and 84 STAR treatments were performed until project launch, while 8/22 centres already recruited VT patients in national clinical trials. The majority currently base their target definition on mapping during VT (96%) and/or pace mapping (75%), reduced voltage areas (63%), or late ventricular potentials (75%) during sinus rhythm. The majority currently apply a single-fraction dose of 25 Gy while planning techniques and dose prescription methods vary greatly. The current clinical STAR practice in the STOPSTORM consortium highlights potential areas of optimization and harmonization for substrate mapping, target delineation, motion management, dosimetry, and QA, which will be addressed in the various WPs.

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“…However, since VT‐SBRT is a novel technique, a range of technical issues still need to be further investigated and optimized. 22 These include cardiac and respiratory motion management, methods for accurate co‐registration of several image modalities (e.g., computed tomography, magnetic resonance and electrocardiographic imaging maps), target volume delineation, and the optimization of treatment beam geometry to provide maximum sparing of proximal organs‐at‐risk (OARs). VT‐SBRT treatment planning performed to date has relied mainly on dose constraints available in Radiation Therapy Oncology Group reports for other SBRT techniques such as those for lung (RTOG 0915) 23 and spine (RTOG 0631), 24 as well as on Task Group Report 101 of the AAPM (TG‐101).…”

Section: Introductionmentioning

confidence: 99%

SBRT of ventricular tachycardia using 4pi optimized trajectories

Reis

Little

MacDonald

et al. 2021

J Applied Clin Med Phys

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To investigate the possible advantages of using 4pi-optimized arc trajectories in stereotactic body radiation therapy of ventricular tachycardia (VT-SBRT) to minimize exposure of healthy tissues. Methods and materials: Thorax computed tomography (CT) data for 15 patients were used for contouring organs at risk (OARs) and defining realistic planning target volumes (PTVs). A conventional trajectory plan, defined as two full coplanar arcs was compared to an optimized-trajectory plan provided by a 4pi algorithm that penalizes geometric overlap of PTV and OARs in the beam's-eye-view. A single fraction of 25 Gy was prescribed to the PTV in both plans and a comparison of dose sparing to OARs was performed based on comparisons of maximum, mean, and median dose. Results: A significant average reduction in maximum dose was observed for esophagus (18%), spinal cord (26%), and trachea (22%) when using 4pioptimized trajectories. Mean doses were also found to decrease for esophagus (19%), spinal cord (33%), skin (18%), liver (59%), lungs (19%), trachea (43%), aorta (11%), inferior vena cava (25%), superior vena cava (33%), and pulmonary trunk (26%). A median dose reduction was observed for esophagus (40%), spinal cord (48%), skin (36%), liver (72%), lungs (41%), stomach (45%), trachea (53%), aorta (45%), superior vena cava (38%), pulmonary veins (32%), and pulmonary trunk (39%). No significant difference was observed for maximum dose (p = 0.650) and homogeneity index (p = 0.156) for the PTV. Average values of conformity number were 0.86 ± 0.05 and 0.77 ± 0.09 for the conventional and 4pi optimized plans respectively. Conclusions: 4pi optimized trajectories provided significant reduction to mean and median doses to cardiac structures close to the target but did not decrease maximum dose. Significant improvement in maximum, mean and median doses for noncardiac OARs makes 4pi optimized trajectories a suitable delivery technique for treating VT.

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A Review of Cardiac Radioablation (CR) for Arrhythmias: Procedures, Technology, and Future Opportunities

Cited by 49 publications

References 80 publications

Feasibility of an Automatic Ultrasonographic Image Acquisition System Associated With an Artificial Intelligence Algorithm for Real-Time Monitoring of Cardiac Motion During Cardiac Radio-Ablation

Feasibility of an Automatic Ultrasonographic Image Acquisition System Associated With an Artificial Intelligence Algorithm for Real-Time Monitoring of Cardiac Motion During Cardiac Radio-Ablation

STereotactic Arrhythmia Radioablation (STAR): the Standardized Treatment and Outcome Platform for Stereotactic Therapy Of Re-entrant tachycardia by a Multidisciplinary consortium (STOPSTORM.eu) and review of current patterns of STAR practice in Europe

SBRT of ventricular tachycardia using 4pi optimized trajectories

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