Jeremy Brownstein1, Muhammad Afzal2, Toshimasa Okabe2, Thura T Harfi2, Matthew S Tong2, Evan Thomas3, Geoffrey Hugo4, Phillip Cuculich5, Cliff Robinson5, Terence M Williams6. 1. Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus Ohio. 2. Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio. 3. Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama. 4. Department of Radiation Oncology, Washington University, St Louis, Missouri. 5. Department of Radiation Oncology, Washington University, St Louis, Missouri; Division of Cardiovascular Medicine, Washington University, St Louis, Missouri. 6. Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus Ohio. Electronic address: Terence.Williams@osumc.edu.
Abstract
PURPOSE: Cardiac radioablation using stereotactic body radiation therapy is gaining popularity as a noninvasive treatment for otherwise refractory ventricular arrhythmias. As radiation oncologists might be unaccustomed to the lexicon used by cardiologists to describe the location of arrhythmogenic foci, a preliminary guide to cardiac-specific anatomy and orientation is needed to foster effective communication between the radiation oncologist and cardiology team. METHODS AND MATERIALS: Electrocardiogram-gated and respiratory-gated computed tomography imaging was acquired per institutional protocol. Additional relevant imaging modalities are described. The American Heart Association 17-segment model is described in detail because this framework is used frequently by cardiologists to describe the location left ventricular abnormalities. RESULTS: A step-by-step guide is provided for properly rotating the heart from standard orthogonal views obtained during radiation simulation to the cardiac-specific orientation needed to appreciate the 17-segment model. Once the proper configuration is achieved, the location of each segment is defined in detail. CONCLUSIONS: This atlas serves as an introduction to the relevant anatomy and principles, and it provides a suggested approach to help delineate cardiac radioablation targets using the established American Heart Association 17-segment model.
PURPOSE: Cardiac radioablation using stereotactic body radiation therapy is gaining popularity as a noninvasive treatment for otherwise refractory ventricular arrhythmias. As radiation oncologists might be unaccustomed to the lexicon used by cardiologists to describe the location of arrhythmogenic foci, a preliminary guide to cardiac-specific anatomy and orientation is needed to foster effective communication between the radiation oncologist and cardiology team. METHODS AND MATERIALS: Electrocardiogram-gated and respiratory-gated computed tomography imaging was acquired per institutional protocol. Additional relevant imaging modalities are described. The American Heart Association 17-segment model is described in detail because this framework is used frequently by cardiologists to describe the location left ventricular abnormalities. RESULTS: A step-by-step guide is provided for properly rotating the heart from standard orthogonal views obtained during radiation simulation to the cardiac-specific orientation needed to appreciate the 17-segment model. Once the proper configuration is achieved, the location of each segment is defined in detail. CONCLUSIONS: This atlas serves as an introduction to the relevant anatomy and principles, and it provides a suggested approach to help delineate cardiac radioablation targets using the established American Heart Association 17-segment model.
Authors: Martijn H van der Ree; Jorrit Visser; R Nils Planken; Edith M T Dieleman; S Matthijs Boekholdt; Brian V Balgobind; Pieter G Postema Journal: Adv Radiat Oncol Date: 2022-03-01