Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Institute for Robotics and Cognitive Systems, University of Lübeck, Lübeck, Germany.
Radiother Oncol. 2024 Nov;200:110499. doi: 10.1016/j.radonc.2024.110499. Epub 2024 Sep 4.
Stereotactic arrhythmia radioablation (STAR) is a therapeutic option for ventricular tachycardia (VT) where catheter-based ablation is not feasible or has previously failed. Target definition and its transfer from electro-anatomic maps (EAM) to radiotherapy treatment planning systems (TPS) is challenging and operator-dependent. Software solutions have been developed to register EAM with cardiac CT and semi-automatically transfer 2D target surface data into 3D CT volume coordinates. Results of a cross-validation study of two conceptually different software solutions using data from the RAVENTA trial (NCT03867747) are reported.
Clinical Target Volumes (CTVs) were created from target regions delineated on EAM using two conceptually different approaches by separate investigators on data of 10 patients, blinded to each other's results. Targets were transferred using 3D-3D registration and 2D-3D registration, respectively. The resulting CTVs were compared in a core-lab using two complementary analysis software packages for structure similarity and geometric characteristics.
Volumes and surface areas of the CTVs created by both methods were comparable: 14.88 ± 11.72 ml versus 15.15 ± 11.35 ml and 44.29 ± 33.63 cm versus 46.43 ± 35.13 cm. The Dice-coefficient was 0.84 ± 0.04; median surface-distance and Hausdorff-distance were 0.53 ± 0.37 mm and 6.91 ± 2.26 mm, respectively. The 3D-center-of-mass difference was 3.62 ± 0.99 mm. Geometrical volume similarity was 0.94 ± 0.05 %.
The STAR targets transferred from EAM to TPS using both software solutions resulted in nearly identical 3D structures. Both solutions can be used for QA (quality assurance) and EAM-to-TPS transfer of STAR-targets. Semi-automated methods could potentially help to avoid mistargeting in STAR and offer standardized workflows for methodically harmonized treatments.
立体定向心律失常放射消融术（STAR）是一种治疗心室性心动过速（VT）的方法，适用于导管消融不可行或先前失败的情况。靶区的定义及其从电解剖图（EAM）到放射治疗计划系统（TPS）的转换具有挑战性且依赖于操作者。已经开发了软件解决方案来将 EAM 与心脏 CT 进行配准，并将 2D 靶区表面数据半自动地转换为 3D CT 容积坐标。本文报道了使用来自 RAVENTA 试验（NCT03867747）的数据进行的两项概念上不同的软件解决方案的交叉验证研究结果。
使用两种概念上不同的方法，由两名独立的研究者分别在 10 名患者的数据上创建从 EAM 上描绘的靶区的临床靶区（CTV），彼此的结果相互盲法。分别使用 3D-3D 配准和 2D-3D 配准来进行靶区的转移。使用两个互补的结构相似性和几何特征分析软件包在核心实验室中对生成的 CTV 进行比较。
两种方法生成的 CTV 体积和表面积相当：14.88 ± 11.72ml 与 15.15 ± 11.35ml，44.29 ± 33.63cm 与 46.43 ± 35.13cm。Dice 系数为 0.84 ± 0.04；中位数表面距离和 Hausdorff 距离分别为 0.53 ± 0.37mm 和 6.91 ± 2.26mm；3D 质心差值为 3.62 ± 0.99mm。几何体积相似度为 0.94 ± 0.05%。
使用两种软件解决方案从 EAM 传输到 TPS 的 STAR 靶区生成了几乎相同的 3D 结构。两种解决方案均可用于 STAR 的 QA（质量保证）和 EAM 到 TPS 的靶区传输。半自动方法可以帮助避免 STAR 中的误靶，并为方法学上协调一致的治疗提供标准化工作流程。
