Quantification of coronary artery motion and internal risk volume from ECG gated radiotherapy planning scans

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• 作者：Tejinder Kataria^a ; Shyam Singh Bisht^a ; ; Deepak Gupta^a ; Ashu Abhishek^a ; Trinanjan Basu^a ; Kushal Narang^a ; Shikha Goyal^a ; Pragya Shukla^b ; Manish Bansal^c ; Hardeep Grewal^c ; Kulbeer Ahlawat^d ; Susovan Banarjee^a ; Manoj Tayal^a
• 关键词：Coronary artery motion ; Internal risk volume ; IRV ; ECG gated ; Thoracic radiotherapy
• 刊名：Radiotherapy and Oncology
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：121
• 期：1
• 页码：59-63
• 全文大小：528 K

文摘

Radiotherapy for carcinoma of breast and thoracic structures involves inadvertent radiation to heart and coronary arteries (CA). Coronary artery stenosis in high radiation dose segments has been documented. Cardiac and respiratory motion induced displacement of CA and internal risk volume (IRV) margin remains inadequately quantified.

Material and methods

Twenty cases of carcinoma breast, lung and lung metastasis were enrolled in this study. ECG gated intravenous contrast enhanced computed tomography (CECT) scans were performed in inspiratory breath hold (IBH) and expiratory breath hold (EBH). The images were segregated into inspiratory systole (IS), inspiratory diastole (ID), expiratory systole (ES) and expiratory diastole (ED) sets. Left anterior descending (LAD), limited segment of LAD close to chest wall (short LAD), right coronary artery (RCA), Left circumflex artery (LCX) and left ventricle (LV) were delineated in all four sets. Mean displacements in systole versus diastole and inspiration versus expiration were calculated in three co-ordinates [anterio-posterior (Z), left–right (X) and cranio-caudal (Y)].

Results

Mean of displacement (mm) between systole and diastole (IS versus ID; and ES versus ED) in X, Y, Z co-ordinates were: LAD 3.0(±1.6), 2.8(±1.5), 3.6(±2.0); Short-LAD 3.0(±1.1), 0.8(±0.4), 2.4(±0.6); LV 2.4(±1.6), 1.7(±1), 5.0(±1.5); LCX 4.9(±1.6), 2.9(±1.3), 5.1(±1.9); RCA 6.6(±2.2), 3.6(±2.1), 5.9(±2.2). Mean displacement between inspiration and expiration (IS versus ES; and ID versus ED) in X, Y, Z axes were: LAD 3.3(±1.5), 8.0(±3.4), 3.8(±1.8); Short-LAD 2.7(±1), 12.2(±4.4), 3.3(±1.5); LV 2.9(±1.4), 9.8(±3.3), 4.7(±1.9); LCX 2.9(±.8), 9.7(±3.2), 6.2(±2.5); RCA 2.6(±1.3), 7.6(±2.5), 3.8(±1.7).

Conclusion

Radial (RM), cranio-caudal margin (CC) of 7 mm, 4 mm in breath-hold radiotherapy whereas RM, CC of 7 mm, 13 mm respectively in free breath radiotherapy will cover the range of motions of CA, LV and can be recommended as IRV for these structures.