Guidance of intracoronary radiation therapy based on dose-volume histograms derived from quantitative intravascular ultrasound.
Application of ionizing radiation to prevent restenosis in atherosclerotic vessels treated by balloon angioplasty is a new treatment under investigation in interventional cardiology and radiology. There is variability in dose prescription, and both gamma- and beta-emitters are used, leading to a wide range of dose distribution over the arterial vessel wall. We present a new modality of dosimetry based on a method that three-dimensional (3-D) image reconstruction of electrocardiogram (ECG)-gated intravascular ultrasound (IVUS) images. Dose volume histograms (DVH) are used to describe the cumulative distribution of dose over two specific volumes: i) at the level of the luminal surface, defined with a thickness of 0.1 mm from the automatically detected contour of the highly echogenic blood-vessel interface, and ii) the adventitia volume is computed considering a 0.5-mm thickness from the echogenic media-adventitia interface. DVH provide a tool for reporting the actual delivered dose at the site believed to be the target: the adventitia, and to detect excessive radiation which could lead to vascular complications. Simulation of a gamma-emitter or of a radioactive source train in the center of the lumen are possible. The data obtained from the first ten patients included in the beta-irradiation trial (BERT 1.5) conducted in our institution are presented, supporting the use of DVH based on quantitative IVUS measurements for optimal dose prescription in vascular interventional radiation therapy.
Carlier
S G
SG
Department of Intervention Cardiology, Thoraxcentre, Erasmus University Rotterdam, The Netherlands. carlier@tch.fgg.eur.nl
Marijnissen
J P
JP
Coen
V L
VL
van der Giessen
W J
WJ
Sabate
M
M
Ligthart
J
J
den Boer
A
A
Céspedes
I E
IE
Li
W
W
van der Steen
A F
AF
Levendag
P C
PC
Serruys
P W
PW
D001918:Brachytherapy; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D018084:Ultrasonography, Interventional