Konermann Sarah L, Gerard Ian J, Bernier Martin L, Hijal Tarek, Stroian Gabriela, Kopek Neil, Alfieri Joanne, El-Hamedi Lynn, Pater Piotr
Medical Physics Unit, Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada.
Division of Radiation Oncology, Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada.
Med Phys. 2025 Feb;52(2):1172-1181. doi: 10.1002/mp.17531. Epub 2024 Nov 29.
Cardiac radioablation (CRA) is a new and promising treatment modality for patients with ventricular tachycardia refractory to standard-of-care treatment. Electroanatomic maps are used to define radiation target volumes; however, there is currently no native method to import electroanatomic maps into the treatment planning system (TPS).
To develop Edico, a semi-automated tool to enable electroanatomic map import into a TPS, by converting electroanatomic maps to a Digital Imaging and COmmunications in Medicine (DICOM) standard. The overall aim is to facilitate target volume delineation and improve workflow efficiency in treating patients.
Edico imports voltage and spatial data from electroanatomic maps and sorts these into voxels to be exported in a DICOM format, with each voxel containing the average voltage value of the data that falls within it. Three different rectangular electroanatomic maps were created and processed using Edico to ensure that expected features are maintained through processing. A sensitivity analysis of voxel size was completed using 19 different electroanatomic maps processed at five different sets of voxel dimensions, for a total of 95 resulting voxelized datasets. The coefficient of variation in each populated voxel in the datasets was analyzed to determine which voxel sizes are necessary to ensure that data loss is kept to a minimum throughout processing, despite averaging. Five electroanatomic maps were used to re-contour clinical target volumes and planning target volumes for previously-treated patients with their electroanatomic maps now directly registered to their planning computed tomography (CT) scans.
All three rectangular test electroanatomic maps were processed as expected. All tested voxel sizes resulted in low coefficients of variation overall, with the exception of the largest voxel size of 1.8 × 1.8 × 8 mm. When using Edico, a user should choose voxel dimensions similar to or smaller than those of a planning CT. Of five pairs of clinical and planning target volumes from previously treated patients, adjustments were made to four (80%), retrospectively, using the electroanatomic maps generated using Edico, registered to the patients' planning CTs.
Edico provides a reliable solution for electroanatomic map import into a TPS and facilitates clinical and planning target volume identification in CRA.
心脏射频消融术（CRA）是一种针对标准治疗无效的室性心动过速患者的新型且有前景的治疗方式。电解剖图用于定义放疗靶区；然而，目前尚无将电解剖图导入治疗计划系统（TPS）的原生方法。
开发Edico，一种通过将电解剖图转换为医学数字成像和通信（DICOM）标准，从而实现将电解剖图导入TPS的半自动工具。总体目标是便于靶区勾画并提高治疗患者的工作流程效率。
Edico从电解剖图中导入电压和空间数据，并将这些数据分类到体素中，以便以DICOM格式导出，每个体素包含落入其中的数据的平均电压值。创建了三个不同的矩形电解剖图，并使用Edico进行处理，以确保在处理过程中保持预期特征。使用19个不同的电解剖图在五组不同的体素尺寸下进行处理，完成了体素大小的敏感性分析，共得到95个体素化数据集。分析数据集中每个填充体素的变异系数，以确定哪些体素大小对于确保在整个处理过程中（尽管进行了平均）将数据丢失保持在最低限度是必要的。使用五个电解剖图对先前治疗患者的临床靶区和计划靶区进行重新勾画，这些患者的电解剖图现在直接与他们的计划计算机断层扫描（CT）扫描配准。
所有三个矩形测试电解剖图均按预期进行处理。除了最大体素尺寸1.8×1.8×8mm外，所有测试的体素大小总体变异系数都很低。使用Edico时，用户应选择与计划CT相似或更小的体素尺寸。在先前治疗患者的五对临床靶区和计划靶区中，回顾性地使用通过Edico生成并与患者计划CT配准的电解剖图，对其中四对（80%）进行了调整。
Edico为将电解剖图导入TPS提供了可靠的解决方案，并有助于心脏射频消融术中临床靶区和计划靶区的识别。
