A novel open‐source software‐based high‐precision workflow for target definition in cardiac radioablation

Abstract

Introduction: Noninvasive ablative radiotherapy of cardiac arrhythmias (stereotactic ablative body radiation) has shown promising initial results. Precise targeting of the arrhythmogenic substrate is paramount to limit adverse effects to healthy myocardium, organs at risk, and cardiac implantable electronic devices. Using electroanatomic maps for treatment planning is technically challenging. Methods and Results: Using the free open-source 3D Slicer software platform we established a workflow for high-precision target definition based on electroanatomic maps. An import plug-in for 3D Slicer has been designed that reads electroanatomic maps generated with three mapping systems in widespread clinical use. Using our proposed workflow in a real-world patient case we were able to align the map to the computed tomography (CT) with a mean distance of 3.1 mm. Thus, points defined on the map were translated into CT space with high accuracy and a radiotherapy treatment volume was defined in CT space based on these mapderived points. Conclusion: We describe a novel high-precision target definition method for stereotactic ablation of cardiac arrhythmias. Multimodal integration of the electroanatomic map with the planning CT allows for highly accurate localization of previously identified electrophysiological features in CT space. It remains to be shown whether this novel planning workflow leads to superior ablation outcomes when compared with other approaches.

Clinical Evidence behind Stereotactic Radiotherapy for the Treatment of Ventricular Tachycardia (STAR)—A Comprehensive Review

“…Fortunately, many authors decided to challenge this problem. For example, in May and July of 2020, Brett et al [ 38 ] and Hohmann et al [ 39 ] published workflow descriptions on converting catheter-based EP maps to DICOM. The software developed by Hohmann et al supports CARTO 3 (Biosense Webster), EnSite Velocity/Precision (Abbott), and RHYTMIA HDx (Boston Scientific) cardiac mapping systems.…”

Stereotactic arrhythmia radiotherapy: a case study of real-time image-guided noninvasive treatment for ventricular tachycardia

“…Therefore, it is necessary to rely on an experienced cardiologist to determine the origin of the VT based on EAM against the reference anatomy and to delineate it on CCTA images as the GTV, for which a respiratory movement range can be generated on r4DCT images. Several studies have reported the registration and fusion workflow of EAM and CT images, providing an objective reference for cardiologists (5,6).…”

Cardiac stereotactic ablative radiotherapy for control of refractory ventricular tachycardia: initial UK multicentre experience

“…In this series, and reflecting current worldwide experience and literature, we used a range of approaches from manual delineation methods to more sophisticated computer-assisted visualisation methods still under development. [26][27][28] The optimum dose and delivery platform for cardiac SABR is yet to be established. We used a single fraction 25 Gy regime as reported by all groups previously.…”