A pulmonary vein atlas for radiotherapy planning

Gerard M Walls; Conor McCann; Peter Ball; Katelyn M Atkins; Raymond H Mak; Ahmed Bedair; Jolyne O'Hare; Jonathan McAleese; Claire Harrison; Karen A Tumelty; Cathryn Crockett; Sarah-Louise Black; Catherine Nelson; John O'Connor; Alan R Hounsell; Conor K McGarry; Karl T Butterworth; Aidan J Cole; Suneil Jain; Gerard G Hanna

doi:10.1016/j.radonc.2023.109680

A pulmonary vein atlas for radiotherapy planning

Gerard M Walls, Conor McCann, Peter Ball, Katelyn M Atkins, Raymond H Mak, Ahmed Bedair, Jolyne O'Hare, Jonathan McAleese, Claire Harrison, Karen A Tumelty, Cathryn Crockett, Sarah-Louise Black, Catherine Nelson, John O'Connor, Alan R Hounsell, Conor K McGarry, Karl T Butterworth, Aidan J Cole, Suneil Jain, Gerard G Hanna

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Abstract

BACKGROUND AND PURPOSE: Cardiac arrhythmia is a recognised potential complication of thoracic radiotherapy, but the responsible cardiac substructures for arrhythmogenesis have not been identified. Arrhythmogenic tissue is commonly located in the pulmonary veins (PVs) of cardiology patients with arrhythmia, however these structures are not currently considered organs-at-risk during radiotherapy planning. A standardised approach to their delineation was developed and evaluated.

MATERIALS AND METHODS: The gross and radiological anatomy relevant to atrial fibrillation was derived from cardiology and radiology literature by a multidisciplinary team. A region of interest and contouring instructions for radiotherapy computed tomography scans were iteratively developed and subsequently evaluated. Radiation oncologists (n = 5) and radiation technologists (n = 2) contoured the PVs on the four-dimensional planning datasets of five patients with locally advanced lung cancer treated with 1.8-2.75 Gy fractions. Contours were compared to reference contours agreed by the researchers using geometric and dosimetric parameters.

RESULTS: The mean dose to the PVs was 35% prescription dose. Geometric and dosimetric similarity of the observer contours with reference contours was fair, with an overall mean Dice of 0.80 ± 0.02. The right superior PV (mean DSC 0.83 ± 0.02) had better overlap than the left (mean DSC 0.80 ± 0.03), but the inferior PVs were equivalent (mean DSC of 0.78). The mean difference in mean dose was 0.79 Gy ± 0.71 (1.46% ± 1.25).

CONCLUSION: A PV atlas with multidisciplinary approval led to reproducible delineation for radiotherapy planning, supporting the utility of the atlas in future clinical radiotherapy cardiotoxicity research encompassing arrhythmia endpoints.

Original language	English
Article number	109680
Journal	Radiotherapy and Oncology
Volume	184
Early online date	25 Apr 2023
DOIs	https://doi.org/10.1016/j.radonc.2023.109680
Publication status	Published (in print/issue) - 31 Jul 2023

Bibliographical note

Funding Information:
This work was performed within the Irish Clinical Academic Training (ICAT) Programme, supported by the Wellcome Trust and the Health Research Board (Grant Number 203930/B/16/Z), the Health Service Executive National Doctors Training and Planning and the Health and Social Care, Research and Development Division, Northern Ireland. None of the the funders had any role in the conduct of the research.

Publisher Copyright:
© 2023 The Authors

Keywords

Humans
Pulmonary Veins/diagnostic imaging
Radiotherapy Planning, Computer-Assisted/methods
Heart
Tomography, X-Ray Computed/methods
Arrhythmias, Cardiac
Organs at Risk
Pulmonary veins
Atrial fibrillation
Lung cancer
Radiation cardiotoxicity
Oesophageal cancer
Cardio-oncology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.radonc.2023.109680

1-s2.0-S0167814023002189-mainFinal published version, 1.78 MBLicence: CC BY

Cite this

Walls, G. M., McCann, C., Ball, P., Atkins, K. M., Mak, R. H., Bedair, A., O'Hare, J., McAleese, J., Harrison, C., Tumelty, K. A., Crockett, C., Black, S.-L., Nelson, C., O'Connor, J., Hounsell, A. R., McGarry, C. K., Butterworth, K. T., Cole, A. J., Jain, S., & Hanna, G. G. (2023). A pulmonary vein atlas for radiotherapy planning. Radiotherapy and Oncology, 184, Article 109680. https://doi.org/10.1016/j.radonc.2023.109680

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title = "A pulmonary vein atlas for radiotherapy planning",

abstract = "BACKGROUND AND PURPOSE: Cardiac arrhythmia is a recognised potential complication of thoracic radiotherapy, but the responsible cardiac substructures for arrhythmogenesis have not been identified. Arrhythmogenic tissue is commonly located in the pulmonary veins (PVs) of cardiology patients with arrhythmia, however these structures are not currently considered organs-at-risk during radiotherapy planning. A standardised approach to their delineation was developed and evaluated.MATERIALS AND METHODS: The gross and radiological anatomy relevant to atrial fibrillation was derived from cardiology and radiology literature by a multidisciplinary team. A region of interest and contouring instructions for radiotherapy computed tomography scans were iteratively developed and subsequently evaluated. Radiation oncologists (n = 5) and radiation technologists (n = 2) contoured the PVs on the four-dimensional planning datasets of five patients with locally advanced lung cancer treated with 1.8-2.75 Gy fractions. Contours were compared to reference contours agreed by the researchers using geometric and dosimetric parameters.RESULTS: The mean dose to the PVs was 35% prescription dose. Geometric and dosimetric similarity of the observer contours with reference contours was fair, with an overall mean Dice of 0.80 ± 0.02. The right superior PV (mean DSC 0.83 ± 0.02) had better overlap than the left (mean DSC 0.80 ± 0.03), but the inferior PVs were equivalent (mean DSC of 0.78). The mean difference in mean dose was 0.79 Gy ± 0.71 (1.46% ± 1.25).CONCLUSION: A PV atlas with multidisciplinary approval led to reproducible delineation for radiotherapy planning, supporting the utility of the atlas in future clinical radiotherapy cardiotoxicity research encompassing arrhythmia endpoints.",

keywords = "Humans, Pulmonary Veins/diagnostic imaging, Radiotherapy Planning, Computer-Assisted/methods, Heart, Tomography, X-Ray Computed/methods, Arrhythmias, Cardiac, Organs at Risk, Pulmonary veins, Atrial fibrillation, Lung cancer, Radiation cardiotoxicity, Oesophageal cancer, Cardio-oncology",

author = "Walls, {Gerard M} and Conor McCann and Peter Ball and Atkins, {Katelyn M} and Mak, {Raymond H} and Ahmed Bedair and Jolyne O'Hare and Jonathan McAleese and Claire Harrison and Tumelty, {Karen A} and Cathryn Crockett and Sarah-Louise Black and Catherine Nelson and John O'Connor and Hounsell, {Alan R} and McGarry, {Conor K} and Butterworth, {Karl T} and Cole, {Aidan J} and Suneil Jain and Hanna, {Gerard G}",

note = "Funding Information: This work was performed within the Irish Clinical Academic Training (ICAT) Programme, supported by the Wellcome Trust and the Health Research Board (Grant Number 203930/B/16/Z), the Health Service Executive National Doctors Training and Planning and the Health and Social Care, Research and Development Division, Northern Ireland. None of the the funders had any role in the conduct of the research. Publisher Copyright: {\textcopyright} 2023 The Authors",

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doi = "10.1016/j.radonc.2023.109680",

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Walls, GM, McCann, C, Ball, P, Atkins, KM, Mak, RH, Bedair, A, O'Hare, J, McAleese, J, Harrison, C, Tumelty, KA, Crockett, C, Black, S-L, Nelson, C, O'Connor, J, Hounsell, AR, McGarry, CK, Butterworth, KT, Cole, AJ, Jain, S & Hanna, GG 2023, 'A pulmonary vein atlas for radiotherapy planning', Radiotherapy and Oncology, vol. 184, 109680. https://doi.org/10.1016/j.radonc.2023.109680

TY - JOUR

T1 - A pulmonary vein atlas for radiotherapy planning

AU - Walls, Gerard M

AU - McCann, Conor

AU - Ball, Peter

AU - Atkins, Katelyn M

AU - Mak, Raymond H

AU - Bedair, Ahmed

AU - O'Hare, Jolyne

AU - McAleese, Jonathan

AU - Harrison, Claire

AU - Tumelty, Karen A

AU - Crockett, Cathryn

AU - Black, Sarah-Louise

AU - Nelson, Catherine

AU - O'Connor, John

AU - Hounsell, Alan R

AU - McGarry, Conor K

AU - Butterworth, Karl T

AU - Cole, Aidan J

AU - Jain, Suneil

AU - Hanna, Gerard G

N1 - Funding Information: This work was performed within the Irish Clinical Academic Training (ICAT) Programme, supported by the Wellcome Trust and the Health Research Board (Grant Number 203930/B/16/Z), the Health Service Executive National Doctors Training and Planning and the Health and Social Care, Research and Development Division, Northern Ireland. None of the the funders had any role in the conduct of the research. Publisher Copyright: © 2023 The Authors

PY - 2023/7/31

Y1 - 2023/7/31

N2 - BACKGROUND AND PURPOSE: Cardiac arrhythmia is a recognised potential complication of thoracic radiotherapy, but the responsible cardiac substructures for arrhythmogenesis have not been identified. Arrhythmogenic tissue is commonly located in the pulmonary veins (PVs) of cardiology patients with arrhythmia, however these structures are not currently considered organs-at-risk during radiotherapy planning. A standardised approach to their delineation was developed and evaluated.MATERIALS AND METHODS: The gross and radiological anatomy relevant to atrial fibrillation was derived from cardiology and radiology literature by a multidisciplinary team. A region of interest and contouring instructions for radiotherapy computed tomography scans were iteratively developed and subsequently evaluated. Radiation oncologists (n = 5) and radiation technologists (n = 2) contoured the PVs on the four-dimensional planning datasets of five patients with locally advanced lung cancer treated with 1.8-2.75 Gy fractions. Contours were compared to reference contours agreed by the researchers using geometric and dosimetric parameters.RESULTS: The mean dose to the PVs was 35% prescription dose. Geometric and dosimetric similarity of the observer contours with reference contours was fair, with an overall mean Dice of 0.80 ± 0.02. The right superior PV (mean DSC 0.83 ± 0.02) had better overlap than the left (mean DSC 0.80 ± 0.03), but the inferior PVs were equivalent (mean DSC of 0.78). The mean difference in mean dose was 0.79 Gy ± 0.71 (1.46% ± 1.25).CONCLUSION: A PV atlas with multidisciplinary approval led to reproducible delineation for radiotherapy planning, supporting the utility of the atlas in future clinical radiotherapy cardiotoxicity research encompassing arrhythmia endpoints.

AB - BACKGROUND AND PURPOSE: Cardiac arrhythmia is a recognised potential complication of thoracic radiotherapy, but the responsible cardiac substructures for arrhythmogenesis have not been identified. Arrhythmogenic tissue is commonly located in the pulmonary veins (PVs) of cardiology patients with arrhythmia, however these structures are not currently considered organs-at-risk during radiotherapy planning. A standardised approach to their delineation was developed and evaluated.MATERIALS AND METHODS: The gross and radiological anatomy relevant to atrial fibrillation was derived from cardiology and radiology literature by a multidisciplinary team. A region of interest and contouring instructions for radiotherapy computed tomography scans were iteratively developed and subsequently evaluated. Radiation oncologists (n = 5) and radiation technologists (n = 2) contoured the PVs on the four-dimensional planning datasets of five patients with locally advanced lung cancer treated with 1.8-2.75 Gy fractions. Contours were compared to reference contours agreed by the researchers using geometric and dosimetric parameters.RESULTS: The mean dose to the PVs was 35% prescription dose. Geometric and dosimetric similarity of the observer contours with reference contours was fair, with an overall mean Dice of 0.80 ± 0.02. The right superior PV (mean DSC 0.83 ± 0.02) had better overlap than the left (mean DSC 0.80 ± 0.03), but the inferior PVs were equivalent (mean DSC of 0.78). The mean difference in mean dose was 0.79 Gy ± 0.71 (1.46% ± 1.25).CONCLUSION: A PV atlas with multidisciplinary approval led to reproducible delineation for radiotherapy planning, supporting the utility of the atlas in future clinical radiotherapy cardiotoxicity research encompassing arrhythmia endpoints.

KW - Humans

KW - Pulmonary Veins/diagnostic imaging

KW - Radiotherapy Planning, Computer-Assisted/methods

KW - Heart

KW - Tomography, X-Ray Computed/methods

KW - Arrhythmias, Cardiac

KW - Organs at Risk

KW - Pulmonary veins

KW - Atrial fibrillation

KW - Lung cancer

KW - Radiation cardiotoxicity

KW - Oesophageal cancer

KW - Cardio-oncology

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U2 - 10.1016/j.radonc.2023.109680

DO - 10.1016/j.radonc.2023.109680

M3 - Article

C2 - 37105303

SN - 0167-8140

VL - 184

JO - Radiotherapy and Oncology

JF - Radiotherapy and Oncology

M1 - 109680

ER -

A pulmonary vein atlas for radiotherapy planning

Abstract

Bibliographical note

Keywords

UN SDGs

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