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International Journal of Radiation Oncology*Biology*Physics
Article . 2026 . Peer-reviewed
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Analyzing Cardiorespiratory Motion and Its Dosimetric Effect on Stereotactic Arrhythmia Radio-Ablation: A STOPSTORM.eu Consortium Study

A STOPSTORM.eu Consortium Study
Authors: Van Der Pol, Luuk; Mandija, Stefano; Balgobind, Brian; Sławomir Blamek; Boda-Heggemann, Judit; Christoph, Marian; Cvek, Jakub; +12 Authors

Analyzing Cardiorespiratory Motion and Its Dosimetric Effect on Stereotactic Arrhythmia Radio-Ablation: A STOPSTORM.eu Consortium Study

Abstract

Stereotactic arrhythmia radio-ablation (STAR) is increasingly used to treat refractory ventricular tachycardia. The importance of cardiorespiratory motion during STAR is still poorly understood. We collected multicenter STOPSTORM.eu data to estimate cardiorespiratory motion and its dosimetric impact on STAR-deliveries.Data were collected from 61 ventricular tachycardia patients. Treatments were performed in free-breathing (FB) with an internal-target volume (FB:ITV) (25 patients), in FB with respiratory beam tracking (FB:TR) (11 patients), using abdominal compression (AC) (10 patients), or in deep inspiration breath-hold (BH) (15 patients). Reference computed tomography images were registered to all breathing/cardiac phases, and the resulting deformation vector fields were used to extract motion for target structures and auto-contoured cardiorespiratory structures (CSs). Additionally, CS were auto-contoured on all breathing/cardiac phases to extract motion independently. Inverse deformation vector fields were used to accumulate motion-adjusted dose distributions. Dose differences were estimated using the conformity index: (VPTV25Gy)2/(VPTV · V25Gy), for planning target volume, and maximum and mean dose differences for CS.The median 95th percentile planning target volume motion was comparable between patients, with 6.0 mm (FB), 5.6 mm (AC), and 4.9 mm (BH). The left ventricle had the highest median 95th percentile motion out of all CS, with 6.8 mm (FB), 5.5 mm (AC), and 5.9 mm (BH). Estimated motion values were comparable between deformable image registration and auto-contouring (FB, 2.9-7.6 vs 3.1-8.5 mm; AC, 2.4-15.1 vs 3.0-9.0 mm; BH, 1.0-7.3 vs 2.4-6.7 mm). Median conformity index was reduced in the accumulated dose compared to the planned dose by: FB:ITV (-7.2%), AC (-14.1%), BH (-4.3%), and FB:TR (-1.3%). Mean CS dose increased by up to 2 Gy, and maximum dose increased by up to 1.2 Gy (excluding outliers). The largest dose differences were found for small CS.Motion and its dosimetric effect have similar magnitudes between treatment setups. Motion findings were consistent between deformable image registration and auto-contouring. Only tracking significantly limited the dosimetric impact of motion.

Countries
Netherlands, Poland
Keywords

Male, Adult, Organs at Risk, Movement, Respiration, Radiotherapy Planning, Computer-Assisted, Heart, Radiotherapy Dosage, Middle Aged, Radiosurgery, Breath Holding, Tachycardia, Ventricular, Humans, Female, Organ Motion, Tomography, X-Ray Computed, Aged

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    influence
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    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
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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!
2
Top 10%
Average
Average
Green
hybrid