Lessons Learned From the First Human Low-Field MRI Guided Radiation Therapy of the Heart in the Presence of an Implantable Cardiac Defibrillator

Gach, H. Michael; Green, Olga L.; Cuculich, Phillip S.; Wittland, Erin J.; Marko, Areti; Luchtefeld, Molly E.; Entwistle, Jill M.; Yang, Deshan; Wilber, David J.; Mutic, Sasa; Robinson, Clifford G.

doi:10.1016/j.prro.2019.02.003

Cited by 15 publications

(8 citation statements)

References 8 publications

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“…Following the recent success of treating VT secondary to cardiac fibroma, we report the first use of SBRT for the treatment of refractory VT secondary to cardiac lipoma. The short‐term outcome in this case suggests that SBRT is a safe and effective treatment option for this type of arrhythmia.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic body radiation therapy for refractory ventricular tachycardia secondary to cardiac lipoma: A case report

Zeng

Huang

Tan

et al. 2019

Pacing Clinical Electrophis

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We present the case of a 29‐year‐old man who developed ventricular tachycardia (VT) secondary to a cardiac lipoma located adjacent to the interventricular groove, which could not be fully resected. Antiarrhythmic drugs and endocardial and epicardial ablation failed to prevent VT recurrence. Finally, noninvasive stereotactic body radiation therapy (SBRT) targeting the lipoma was performed, with a total dose of 24 Gy delivered in three fractions. The number of VT episodes was reduced from 189/24 h before SBRT to 0 after the procedure. At 4‐month follow‐up, there were no signs of therapy‐related complications. Our experience suggests that SBRT could emerge as a viable treatment option for patients with cardiac tumors who develop refractory ventricular arrhythmias.

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Section: Discussionmentioning

confidence: 99%

Stereotactic body radiation therapy for refractory ventricular tachycardia secondary to cardiac lipoma: A case report

Zeng

Huang

Tan

et al. 2019

Pacing Clinical Electrophis

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“…Because the MRIdian system is a 0.35 T onboard MR scanner, we had to clear and consent our patient to off-label scanning at 0.35 T. Scanning implanted devices at low-field versus high-field strength is expedient because of the reduced specific absorption rate, 17 reduced null band artifacts, 18 reduced magnetic susceptibility, 19 and overall reduced ferromagnetic pull on the magnetic implant. Additionally, there are fewer spatial distortion effects due to less perturbation of magnetic susceptibility from the introduced implant.…”

Section: Discussionmentioning

confidence: 99%

The First Report of Using Low-Field MRI-Guided Radiation Therapy in a Patient With a Cochlear Implant

Ziegler,

McCulloch,

Bassiri

et al. 2024

Advances in Radiation Oncology

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“…Improved SNR and contrast‐to‐noise ratio may be achievable at 0.35 T using a balanced steady‐state free precession (bSSFP) version of CAPTURE 52,54 . However, the T 1 ‐weighted CAPTURE is much less sensitive than the current ViewRay bSSFP sequences to banding artifacts from implanted metal typically found in the patient population 55 …”

Section: Discussionmentioning

confidence: 99%

“…52,54 However, the T 1weighted CAPTURE is much less sensitive than the current ViewRay bSSFP sequences to banding artifacts from implanted metal typically found in the patient population. 55…”

Section: Discussionmentioning

confidence: 99%

Respiratory motion management using a single rapid MRI scan for a 0.35 T MRI‐Linac system

et al. 2023

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BackgroundMRI has a rapidly growing role in radiation therapy (RT) for treatment planning, real‐time image guidance, and beam gating (e.g., MRI‐Linac). Free‐breathing 4D‐MRI is desirable in respiratory motion management for therapy. Moreover, high‐quality 3D‐MRIs without motion artifacts are needed to delineate lesions. Existing MRI methods require multiple scans with lengthy acquisition times or are limited by low spatial resolution, contrast, and signal‐to‐noise ratio.PurposeWe developed a novel method to obtain motion‐resolved 4D‐MRIs and motion‐integrated 3D‐MRI reconstruction using a single rapid (35‐45 s scan on a 0.35 T MRI‐Linac.MethodsGolden‐angle radial stack‐of‐stars MRI scans were acquired from a respiratory motion phantom and 12 healthy volunteers (n = 12) on a 0.35 T MRI‐Linac. A self‐navigated method was employed to detect respiratory motion using 2000 (acquisition time = 5–7 min) and the first 200 spokes (acquisition time = 35–45 s). Multi‐coil non‐uniform fast Fourier transform (MCNUFFT), compressed sensing (CS), and deep‐learning Phase2Phase (P2P) methods were employed to reconstruct motion‐resolved 4D‐MRI using 2000 spokes (MCNUFFT2000) and 200 spokes (CS200 and P2P200). Deformable motion vector fields (MVFs) were computed from the 4D‐MRIs and used to reconstruct motion‐corrected 3D‐MRIs with the MOtion Transformation Integrated forward‐Fourier (MOTIF) method. Image quality was evaluated quantitatively using the structural similarity index measure (SSIM) and the root mean square error (RMSE), and qualitatively in a blinded radiological review.ResultsEvaluation using the respiratory motion phantom experiment showed that the proposed method reversed the effects of motion blurring and restored edge sharpness. In the human study, P2P200 had smaller inaccuracy in MVFs estimation than CS200. P2P200 had significantly greater SSIMs (p < 0.0001) and smaller RMSEs (p < 0.001) than CS200 in motion‐resolved 4D‐MRI and motion‐corrected 3D‐MRI. The radiological review found that MOTIF 3D‐MRIs using MCNUFFT2000 exhibited the highest image quality (scoring > 8 out of 10), followed by P2P200 (scoring > 5 out of 10), and then motion‐uncorrected (scoring < 3 out of 10) in sharpness, contrast, and artifact‐freeness.ConclusionsWe have successfully demonstrated a method for respiratory motion management for MRI‐guided RT. The method integrated self‐navigated respiratory motion detection, deep‐learning P2P 4D‐MRI reconstruction, and a motion integrated reconstruction (MOTIF) for 3D‐MRI using a single rapid MRI scan (35‐45 s) on a 0.35 T MRI‐Linac system.

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Lessons Learned From the First Human Low-Field MRI Guided Radiation Therapy of the Heart in the Presence of an Implantable Cardiac Defibrillator

Cited by 15 publications

References 8 publications

Stereotactic body radiation therapy for refractory ventricular tachycardia secondary to cardiac lipoma: A case report

Stereotactic body radiation therapy for refractory ventricular tachycardia secondary to cardiac lipoma: A case report

The First Report of Using Low-Field MRI-Guided Radiation Therapy in a Patient With a Cochlear Implant

Respiratory motion management using a single rapid MRI scan for a 0.35 T MRI‐Linac system

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