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Article . 2025 . Peer-reviewed
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Article . 2025
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Excellent interobserver agreement and steep learning curve for target volume delineation for stereotactic arrhythmia radioablation using a commercial software

Authors: Robert Rademaker; Simon Cirkel; Sharif Omara; Frank J W M Dankers; Marek Sramko; J Solana Munoz; Yesim S Kaya; +7 Authors

Excellent interobserver agreement and steep learning curve for target volume delineation for stereotactic arrhythmia radioablation using a commercial software

Abstract

Abstract Aims Stereotactic arrhythmia radioablation (STAR) has emerged as bail-out treatment for ventricular tachycardia (VT). Accurate, reproducible, and easy-to-use data transfer from electroanatomical mapping (EAM) systems to radiotherapy planning CT is desirable. We aim to evaluate interobserver variability, ease of use, and learning curve for EAM based target volume (CardTV-EPinv) creation and transfer using available software packages. Methods and results In patients considered for STAR, CardTV-EPinv were created using ADAS and Slicer3D for workflow comparison. Four CardTV-EPinv (clinically targeted volume and three mock targets) were created by an experienced operator and a 2nd-year medical student, based on endocardial EAM tags indicating VT substrate location. CardTV-EPinv sizes, Hausdorff distances (HDs), and workflow duration were measured to assess interobserver variability and learning curve. Agreement between CardTV-EPinv was high using ADAS and Slicer3D workflows (HD 3.64 mm [2.7–4.5]). ADAS workflow was faster and more robust (ADAS 26 min [24–29] vs. Slicer3D 65 min [61–70], P < 0.001; system crashes: ADAS 0 vs. Slicer3D 7). In 20 patients (80% non-ischaemic cardiomyopathy, LVEF 35 ± 14%), 80 CardTV-EPinv were created using ADAS. CardTV-EPinv size was similar for both observers (11.8 mL [10.1–13.7] vs. 10.7 mL [9.6–11.8], P = 0.17), with high interobserver agreement (HD 1.68 mm [1.45–1.96]; 95th percentile HD < 4.8 mm [3.5–5.7]). Linear regression showed a steep learning curve for the student (P = 0.01). Conclusion CardTV-EPinv creation showed excellent interobserver agreement and was faster and more robust using ADAS than 3D slicer. The steep learning curve appears clinically relevant given the limited use of STAR even in high-volume VT ablation centres.

Country
Netherlands
Keywords

STAR, Humans; Learning Curve; Observer Variation; Radiosurgery/methods; Software; Tachycardia, Ventricular/physiopathology; Tachycardia, Ventricular/surgery; Tachycardia, Ventricular/diagnostic imaging; Tachycardia, Ventricular/radiotherapy; Tachycardia, Ventricular/diagnosis; Reproducibility of Results; Workflow; Electrophysiologic Techniques, Cardiac; Radiotherapy Planning, Computer-Assisted/methods; Female; Male; Predictive Value of Tests; Treatment Outcome; Tomography, X-Ray Computed; Ablation; Interobserver variability in imaging and EAM merging; STAR; Stereotactic arrhythmia radioablation; Ventricular tachycardia, Clinical Research, Stereotactic arrhythmia radioablation, Ventricular tachycardia, Interobserver variability in imaging and EAM merging, Ablation

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
1
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