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Comparative study of electrocardiogram-gated computed tomography (CT) and respiratory four-dimensional CT for

Zhonghua Deng1, Huiling Ye1,2, Yingjie Zhang1

  • 1Radiotherapy Physics & Technology Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.

Quantitative Imaging in Medicine and Surgery
|July 3, 2025
PubMed

Insights

Four-dimensional computed tomography (4D CT) better assesses cardiac substructure motion than electrocardiogram-gated CT (ECG-CT), especially in the superior-inferior direction. A 4D CT gating plan effectively reduces radiation dose for breast cancer patients.

Area of Science:

  • Medical Imaging
  • Radiotherapy Physics
  • Cardiovascular Imaging

Background:

  • Electrocardiogram-gated computed tomography (ECG-CT) offers high temporal resolution but struggles with respiratory motion.
  • Cardiac motion encompasses both pulsatile activity and respiratory movement, posing challenges for ECG-CT.
  • Four-dimensional computed tomography (4D CT) integrates both cardiac and respiratory motion for comprehensive assessment.

Purpose of the Study:

  • Compare cardiac substructure motion evaluation between ECG-CT and 4D CT.
  • Evaluate a 4D CT-based gating plan for breast cancer patients.
  • Explore image registration methods for cardiac radiation therapy.

Main Methods:

  • 20 left-sided breast cancer patients underwent both ECG-CT and 4D CT.
  • Evaluated cardiac substructure motion using parameters like absolute motion, volume increment ratios, Dice similarity coefficient (DSC), and Hausdorff distance (HD).
  • Utilized three optimal phases from 4D CT for a gating plan to assess cardiac substructure radiation dose.

Main Results:

  • 4D CT demonstrated significantly smaller motion in the superior-inferior (SI) direction for most cardiac substructures compared to ECG-CT.
  • ECG-CT showed significantly larger motion in right-left (RL) and anterior-posterior (AP) directions for several substructures.
  • The 4D CT-based gating plan resulted in significantly lower radiation doses to cardiac substructures compared to the average intensity projection (AIP) plan.

Conclusions:

  • 4D CT is superior to ECG-CT for evaluating cardiac substructure motion, particularly in the SI direction.
  • A 4D CT-based gating plan offers a viable method for reducing radiation dose to the left anterior descending (LAD) artery when deep-inspiration breath-hold (DIBH) is not feasible.
  • The heart, descending aorta (DAo), and right atrium + right ventricle (RA + RV) are suitable reference structures for cardiac radiation therapy planning.
Abstract

Keywords:
Electrocardiogram-gated computed tomography (ECG-CT)breast cancer patientscardiac radiation ablationcardiac substructure motionfour-dimensional computed tomography (4D CT)

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