MRI-guided cardiac-induced target motion tracking for atrial fibrillation cardiac radioablation

Abstract

Background and purpose: Atrial fibrillation (AF) cardiac radioablation (CR) challenges radiotherapy tracking: multiple small targets close to organs-at-risk undergo rapid differential cardiac contraction and respiratory motion. MR-guidance offers a real-time target tracking solution. This work develops and investigates MRI-guided tracking of AF CR targets with cardiac-induced motion.

Materials and methods: A direct tracking method (Tracking_direct) and two indirect tracking methods leveraging population-based surrogacy relationships with the left atria (Tracking_{indirect_LA}) or other target (Tracking_{indirect_target}) were developed. Tracking performance was evaluated using transverse ECG-gated breathhold MRI images from 15 healthy and 10 AF participants. Geometric and volumetric tracking errors were calculated, defined as the difference between the ground-truth and tracked target centroids and volumes respectively. Transverse, breath-hold, noncardiac-gated cine images were acquired at 4 Hz in 5 healthy and 5 AF participants to qualitatively characterize tracking performance on images more comparable to MRILinac acquisitions.

Results: The average 3D geometric tracking errors for Tracking_direct, Tracking_{indirect_LA} and Tracking_{indirect_target} respectively were 1.7 ± 1.2 mm, 1.6 ± 1.1 mm and 1.9 ± 1.3 mm in healthy participants and 1.7 ± 1.3 mm, 1.5 ± 1.0 mm and 1.7 ± 1.2 mm in AF participants. For Tracking_direct, 88% of analyzed images had 3D geometric tracking errors <3 mm and the average volume tracking error was 1.7 ± 1.3 cc. For Tracking_direct on non-cardiac-gated cine images, tracked targets overlapped organsat-risk or completely missed the target area on 2.2% and 0.08% of the images respectively.

Conclusion: The feasibility of non-invasive MRI-guided tracking of cardiac-induced AF CR target motion was demonstrated for the first time, showing potential for improving AF CR treatment efficacy.

Keywords: Atrial fibrillation; Cardiac arrhythmias; MRI-Linac; Non-invasive; Radioablation; Stereotactic radiotherapy.