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Multi-lead Monitoring to Deduce Translations and Rotations of the Heart Through Respiration and Its Geometric
Jakob Marshall1, Tania Karan2, Alanah Bergman3
1Department of Physics, University of British Columbia, Vancouver, British Columbia, Canada; Department of Medical Physics, BC Cancer, Vancouver, British Columbia, Canada.
Purpose:
To investigate the time-resolved translations and rotations of the heart through respiration and their impact on target localization accuracy in cardiac radioablation (CR).
Methods And Materials:
Twelve patient data sets, from 6 patients, were acquired with 5 Hz, biplanar kV, fluoroscopy for 15 to 20 seconds in preparation for CR. Each patient was imaged twice, with and without abdominal compression. Included patients undergoing CR had implanted cardiac leads in the right ventricle (RV), right atrium (RA), and left ventricle (LV). Time-resolved respiratory motion for each cardiac lead was determined by monitoring the lead tip in biplanar images, triangulating its 3D position, and low-pass filtering its motion. The following 3 motion compensation strategies to model the target's position were simulated: (1) no respiratory motion compensation; (2) RV lead respiratory compensation; and (3) 6-degree-of-freedom (6DoF) respiratory motion modeling using all 3 cardiac leads. The 6DoF model also enabled quantification of the time-resolved translation and rotations of the cardiac lead cluster due to respiration. Each scenario was evaluated on its ability to predict the position of an independent pseudotarget, represented by the most proximal LV lead electrode, on the lateral wall of the LV.
Results:
The average rotational amplitude of the cardiac lead cluster through respiration was 2.4∘±0.6° (right-left), 1.3° ± 0.4° (superior-inferior), and 1.7° ± 0.7° (anterior-posterior). For each patient, 6DoF respiratory motion compensation significantly (P≤.001) reduced respiratory motion localization errors compared with no motion compensation and RV lead only compensation. The average magnitude of 3D localization errors in respiratory motion compensation was 2.8 ± 1.1 mm without motion compensation, 2.0 ± 1.0 mm with RV lead compensation, and 0.8 ± 0.4 mm with 6DoF motion modeling.
Conclusions:
The rotation of the heart through respiration in CR, and its importance for real-time motion monitoring, is presented for the first time. For each patient data set, 6DoF modeling significantly improved the accuracy of respiratory motion localization for pseudotargets on the lateral wall of the LV.
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