ArticleQuantitative imaging in medicine and surgery2026
Dosimetric characteristics of cardiorespiratory motion during cardiac stereotactic body radiotherapy and dose gain from respiratory gating.
Article in Quantitative imaging in medicine and surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Cardiac stereotactic body radiotherapy (CSBRT) is a promising new option for patients with refractory arrhythmias, but complex combined cardiopulmonary motion poses a challenge for precise CSBRT treatment. At present, the dosimetric effects of cardiopulmonary motion on the actual delivery of CSBRT are still unclear, which may deter its widespread clinical application. This study aimed to evaluate the dosimetric effects of complex cardiorespiratory motion during CSBRT and explore the dosimetric advantages of respiratory gating. Methods: A dynamic cardiac phantom was used to simulate different patterns of cardiac pulsation, respiratory motion, and cardiorespiratory motion. Radiochromic film was used to measure the dose, with radiation doses measured for both free-breathing and respiratory-gated CSBRT across various motion pattern groups. The dose measured with a static phantom served as the reference. Subsequently, the measured dose distributions were compared with that of the reference to evaluate the dose difference, gamma passing rate (GPR), isodose width (IDW), and penumbra width. Results: Increased cardiorespiratory motion in CSBRT led to a decreased GPR (3%/2 mm), reduced 90% and 80% IDWs, and a broadened penumbra. Dose-blurring and interplay effects were also observed. Under free-breathing delivery, the mean GPR at the 3%/2 mm criterion was 42.6% in the large‑motion group. Compared with free-breathing delivery, respiratory‑gated delivery increased the mean GPR for the 3%/2 mm criterion by 19.4%. Respiratory amplitude had the greatest dosimetric effect, while heart rate, respiratory cycle, and onset phase had minimal effects. Conclusions: Cardiorespiratory motion introduced dose uncertainties and interplay effects during CSBRT, leading to dose variations in the target and non-uniform dose distributions in the peripheral region surrounding the target, including cold and hot spots. The adoption of gating techniques substantially improved dose precision in CSBRT, effectively mitigating dose uncertainties associated with cardiorespiratory motion. Our findings highlight the importance of implementing respiratory motion management techniques to enhance the effectiveness and safety of CSBRT.
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