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Updated: Jun 18, 2026

Percutaneous Contrast Echocardiography-guided Intramyocardial Injection and Cell Delivery in a Large Preclinical Model
14:24

Percutaneous Contrast Echocardiography-guided Intramyocardial Injection and Cell Delivery in a Large Preclinical Model

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Heart Substructure Radiation Dose and Cardiac Outcomes: Contemporary Evidence and Actionable Opportunities: JACC

Katelyn M Atkins1, Gerard Walls2, Andriana P Nikolova3

  • 1Department of Radiation Oncology, Samuel Oschin Cancer Center, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA. Electronic address: https://twitter.com/_katelynatkins.

JACC. Cardiooncology
|June 17, 2026
PubMed

Insights

Radiation dose to specific heart structures, not the whole heart, predicts cardiac events like ischemia and heart failure. Bridging the gap between this evidence and clinical practice is crucial for better radiotherapy care.

Area of Science:

  • Cardiovascular research
  • Radiation oncology
  • Clinical implementation science

Background:

  • Cardiac substructure radiation dose is a stronger predictor of specific cardiac events (ischemia, heart failure, arrhythmia) than whole-heart metrics.
  • A gap exists between emerging evidence on cardiac dosimetry and its integration into clinical practice and guidelines.
  • Current cardio-oncology guidelines lack actionable radiation dose thresholds for cardiac substructures.

Purpose of the Study:

  • To review contemporary cardiac dosimetry evidence and its link to cardiac outcomes.
  • To propose a clinical framework for integrating cardiac radiation dose metrics.
  • To outline strategies for improving evidence-to-practice translation in radiotherapy.

Main Methods:

  • Systematic review of contemporary cardiac dosimetry research.
  • Synthesis of evidence linking radiation dose to specific cardiac substructures and clinical outcomes.
  • Development of a clinically-oriented framework for radiotherapy planning.

Main Results:

  • Discrete cardiac substructure dosimetry significantly predicts specific adverse cardiac events.
  • Existing guidelines offer limited actionable dose thresholds for substructures.
  • Evidence-practice gap is influenced by workflow, consensus, and clinical trial integration.

Conclusions:

  • Focusing on specific cardiac substructures in radiation planning improves outcome prediction.
  • A pragmatic framework is needed to translate dosimetry evidence into clinical guidance.
  • Actionable strategies are required to accelerate the adoption of cardiac dosimetry in radiotherapy.

Keywords:
LADMACEcardiac eventscardiac substructurecardiac toxicityradiation therapy

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