Development of the medical workflow and gating tools for ventricular tachycardia ablation with high-energy ion beams at MedAustron

Abstract

Ventricular tachycardia is a life-threatening condition that increases the probability of sudden cardiac failure. Stereotactic ablative radiotherapy has been performed as an effective life-saving treatment for refractory (resistant to pharmaceutical and interventional treatment) patients. Ion beam radiotherapy can deposit targeted energy at a specified depth. Allowing for higher conformity of the dose distribution and improved organs at risk sparing. For this type of external beam radiation therapy novel gating tools, synchronization, and surface monitoring devices that account for moving targets like the heart, and respiration dynamics are being explored to further favour treatment accuracy. This work provides a prospective medical workflow to potentially accomplish life-saving ventricular tachycardia treatments with high energy particle beams at the therapy and research centre MedAustron (Wiener Neustadt,Austria). In-house accelerator gating technology,external triggering signals and devices that could aid this specific treatment indication were assessed. As a result, the missing tools, possible bottlenecks and interoperability shortcomings were identified and solutions recommended. Additionally, three treatment planning case studies were performed to propose a suitable treatment dose, organs at risk,clinical goals and constraints. Furthermore, cross-platform medical image compatibility with the locally available tools based on the stereotactic photon therapy experience was investigated. Electroanatomical mapping data extraction, processing and target migration options were outlined and benchmarked based on state-of-the-art literature and expert consultations. Future developments encompass simulating, testing and streamlining the entire medical workflow considering beam gating, respiration dynamics, cross-platform image compatibility and evaluating the impact of a novel cardiac gating ultrasound probe with an anthropomorphic 4D phantom. In addition. the exploration of biological effects(e.g. stenosis, depolarization or protein activation) at different doses in cardiac tissue cells is to be investigated.