Key result
A 4D CT-based gating plan significantly reduced the radiation dose to the left anterior descending artery compared to an average intensity projection plan (1,685.85 vs. 1,844.05 cGy) in left-sided breast cancer patients.
Why the study?
Cardiac motion includes both pulsatile activity and respiratory movement, making it challenging for ECG-CT to capture full respiratory motion compared with respiratory-gated 4D CT.
Does 4D CT improve the evaluation of cardiac substructure motion and reduce LAD dose compared to ECG-CT in left-sided breast cancer patients undergoing radiotherapy?
Observational (n=20)
No
Does 4D CT improve the evaluation of cardiac substructure motion and reduce LAD dose compared to ECG-CT in left-sided breast cancer patients undergoing radiotherapy?
4D CT is superior to ECG-CT for evaluating cardiac substructure motion in the superior-inferior direction and enables a gating plan that significantly reduces the radiation dose to the left anterior descending artery in breast cancer patients.
4D CT gating may lower LAD dose in left breast RT; leaves open need for randomized outcome trials.
Background: Theoretically, electrocardiogram-gated computed tomography (ECG-CT) can more precisely characterize the motion of a beating heart. However, cardiac motion involves both pulsatile cardiac activity and respiratory-induced movement. ECG-CT has high temporal resolution and fast scanning speed, requiring image acquisition to be completed within a single cardiac cycle. As a result, it is challenging to assess the full range of respiratory motion. In contrast, respiratory-gated four-dimensional computed tomography (4D CT) enables synchronized integration of both cardiac pulsation and respiratory motion. This study aimed to compare cardiac substructure motion using ECG-CT versus 4D CT, evaluate a gating plan for breast cancer patients, and explore an image registration method in cardiac radiation. Methods: A total of 20 left-sided breast cancer patients underwent both ECG-CT and 4D CT scanning. Parameters such as the absolute motion, volume increment ratios, the Dice similarity coefficient (DSC), and the Hausdorff distance (HD) of cardiac substructures were evaluated. Additionally, unlike ECG-CT, 4D CT offered inherent gating capability. Therefore, three optimal phases from 4D CT were utilized for the gating plan to assess the dose of cardiac substructures. Results: 1,844.05±394.43 cGy, P<0.01). Conclusions: 4D CT is a superior method for evaluating the motion of cardiac substructures compared to ECG-CT in the SI direction. A 4D CT-based gating plan provides a viable alternative to reducing the LAD dose when deep-inspiration breath-hold (DIBH) is unavailable. Furthermore, the heart, descending aorta (DAo), and RA + RV can serve as reference structures for cardiac radiation ablation.
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Deng et al. (2025) conducted an observational in Left-sided breast cancer (n=20). 4D CT-based gating plan vs. Average intensity projection (AIP) plan was evaluated on Left anterior descending (LAD) artery dose (p=<0.01). A 4D CT-based gating plan significantly reduced the radiation dose to the left anterior descending artery compared to an average intensity projection plan (1,685.85 vs. 1,844.05 cGy) in left-sided breast cancer patients.
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