Radiosurgery Beyond Cancer: Real-Time Target Localization and Treatment Planning for Cardiac Radiosurgery Under MRI Guidance
S Ipsen1,6*, O Blanck2 , B Oborn3 , F Bode4 , G Liney5 , P Keall6 , (1) University of Luebeck, Luebeck, SH, (2) CyberKnife Zentrum Norddeutschland, Guestrow, MV, (3) Illawarra Cancer Care Centre, Wollongong, NSW, (4) Medical Clinic II, Section for Electrophysiology, UKSH, Luebeck, SH, (5) Ingham Institute for Applied Medical Research, Liverpool, NSW, (6) University of Sydney, Camperdown
PresentationsMO-A-BRD-8 Monday 7:30AM - 9:30AM Room: Ballroom D
Purpose: Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting >2.5M Americans and >4.5M Europeans. AF is usually treated with minimally-invasive, time consuming catheter ablation techniques. Radiosurgery of the pulmonary veins (PV) has been proposed for AF treatment, however is challenging due to the complex respiratory and cardiac motion patterns. We hypothesize that an MRI-linac could solve the difficult real-time targeting and adaptation problem. In this study we quantified target motion ranges on cardiac MRI and analyzed the dosimetric benefits of margin reduction assuming real-time MRI tracking was applied.
Methods: For the motion study, four human subjects underwent real-time cardiac MRI under free breathing. The target motion on coronal and axial cine planes was analyzed using a template matching algorithm. For the planning study, an ablation line at each PV antrum was defined as target on an AF patient scheduled for catheter ablation. Various safety margins ranging from 0mm (perfect tracking) to 8mm (untracked motion) were added to the target defining the PTV. 30Gy single fraction IMRT plans were then generated. Finally, the influence of a 1T magnetic field on treatment beam delivery was calculated using the Geant4 Monte Carlo algorithm to simulate the dosimetric impact of MRI guidance.
Results: The motion study showed the mean respiratory motion of the target area on MRI was 8.4mm (SI), 1.7mm (AP) and 0.3mm (LR). Cardiac motion was small (<2mm). The planning study showed that with increasing safety margins to encompass untracked motion, dose tolerances for OARs such as the esophagus and airways were exceeded by >100%. The magnetic field had little impact on the dose distribution.
Conclusion: Our results indicate that real-time MRI tracking of the PVs seems feasible. Accurate image guidance for high-dose AF radiosurgery is essential since safety margins covering untracked target motion will result in unacceptable treatment plans.