SU-C-303-06: Treatment Planning Study for Non-Invasive Cardiac Arrhythmia Ablation with Scanned Carbon Ions in An Animal Model

Authors

  • Eichhorn A,

    1. GSI Helmholtz Center, Darmstadt, DE
    2. Mayo Clinic, Rochester, Minnesota
    3. University of Heidelberg, Heidelberg, DE
    4. University Clinic Erlangen, Erlagen, DE
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  • Constantinescu A,

    1. GSI Helmholtz Center, Darmstadt, DE
    2. Mayo Clinic, Rochester, Minnesota
    3. University of Heidelberg, Heidelberg, DE
    4. University Clinic Erlangen, Erlagen, DE
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  • Lehmann H I,

    1. GSI Helmholtz Center, Darmstadt, DE
    2. Mayo Clinic, Rochester, Minnesota
    3. University of Heidelberg, Heidelberg, DE
    4. University Clinic Erlangen, Erlagen, DE
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  • Lugenbiel P,

    1. GSI Helmholtz Center, Darmstadt, DE
    2. Mayo Clinic, Rochester, Minnesota
    3. University of Heidelberg, Heidelberg, DE
    4. University Clinic Erlangen, Erlagen, DE
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  • Takami M,

    1. GSI Helmholtz Center, Darmstadt, DE
    2. Mayo Clinic, Rochester, Minnesota
    3. University of Heidelberg, Heidelberg, DE
    4. University Clinic Erlangen, Erlagen, DE
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  • Richter D,

    1. GSI Helmholtz Center, Darmstadt, DE
    2. Mayo Clinic, Rochester, Minnesota
    3. University of Heidelberg, Heidelberg, DE
    4. University Clinic Erlangen, Erlagen, DE
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  • Prall M,

    1. GSI Helmholtz Center, Darmstadt, DE
    2. Mayo Clinic, Rochester, Minnesota
    3. University of Heidelberg, Heidelberg, DE
    4. University Clinic Erlangen, Erlagen, DE
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  • Kaderka R,

    1. GSI Helmholtz Center, Darmstadt, DE
    2. Mayo Clinic, Rochester, Minnesota
    3. University of Heidelberg, Heidelberg, DE
    4. University Clinic Erlangen, Erlagen, DE
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  • Thomas D,

    1. GSI Helmholtz Center, Darmstadt, DE
    2. Mayo Clinic, Rochester, Minnesota
    3. University of Heidelberg, Heidelberg, DE
    4. University Clinic Erlangen, Erlagen, DE
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  • Bert C,

    1. GSI Helmholtz Center, Darmstadt, DE
    2. Mayo Clinic, Rochester, Minnesota
    3. University of Heidelberg, Heidelberg, DE
    4. University Clinic Erlangen, Erlagen, DE
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  • Packer D L,

    1. GSI Helmholtz Center, Darmstadt, DE
    2. Mayo Clinic, Rochester, Minnesota
    3. University of Heidelberg, Heidelberg, DE
    4. University Clinic Erlangen, Erlagen, DE
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  • Durante M,

    1. GSI Helmholtz Center, Darmstadt, DE
    2. Mayo Clinic, Rochester, Minnesota
    3. University of Heidelberg, Heidelberg, DE
    4. University Clinic Erlangen, Erlagen, DE
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  • Graeff C

    1. GSI Helmholtz Center, Darmstadt, DE
    2. Mayo Clinic, Rochester, Minnesota
    3. University of Heidelberg, Heidelberg, DE
    4. University Clinic Erlangen, Erlagen, DE
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Abstract

Purpose:

Scanned carbon ion beams might offer a non-invasive alternative treatment for cardiac arrhythmia, which are a major health-burden. We studied the feasibility of this procedure in an animal model. The underlying treatment planning and motion mitigation strategies will be presented.

Methods:

The study was carried out in 15 pigs, randomly distributed to 3 target groups: atrioventricular node (AVN, 8 animals with 25, 40, and 55 Gy target dose), left ventricular free-wall (LV, 4 animals with 40 Gy) and superior pulmonary vein (SPV, 3 animals with 40 Gy). Breathing motion was suppressed by repeated enforced breathholds at end exhale. Cardiac motion was mitigated by an inhomogeneous rescanning scheme with up to 15 rescans. The treatment planning was performed using the GSI in-house software TRiP4D on cardiac-gated 4DCTs, applying a range-considering ITV based on an extended CTV. For AVN and SPV isotropic 5 mm margins were applied to the CTV, while for the LV 2mm+2% range margins were used. The opposing fields for AVN and LV targets were optimized independently (SFUD), while SPV treatments were optimized as IMPT deliveries, including dose restrictions to the radiosensitive AVN.

Results:

Median value of D95 over all rescanning simulations was 99.1% (AVN), 98.0% (SPV) and 98.3% (LV) for the CTV and 94.7% (AVN) and 92.7% (SPV) for the PTV, respectively. The median D5-D95 was improved with rescanning compared to unmitigated delivery from 13.3 to 6.5% (CTV) and from 23.4 to 11.6% (PTV). ICRP dose limits for aorta, trachea, esophagus and skin were respected. The maximal dose in the coronary arteries was limited to 30 Gy.

Conclusion:

We demonstrated the feasibility of a homogeneous dose delivery to different cardiac structures in a porcine model using a time-optimized inhomogeneous rescanning scheme. The presented treatment planning strategies were applied in a pig study with the analysis ongoing.

Funding: This work was supported in part by the Helmholtz Association, the American Heart Association Midwest Affiliate Postdoctoral Fellowship Grant, the Mayo Clinic Foundation, and the Goldsmith Foundation.

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