Guidance of intracoronary radiation therapy based on dose-volume histograms derived from quantitative intravascular ultrasound

• Published in: IEEE transactions on medical imaging Vol. 17; no. 5; pp. 772 - 778
• Main Authors: Carlier, S.G., Marijnissen, J.P.A., Coen, V.L.M.A., van der Giessen, W.J., Sabate, M., Ligthart, J., den Boer, A., Cespedes, I.E., Wenguang Li, van der Steen, A.F.W., Levendag, P.C., Serruys, P.W.
• Format: Journal Article
• Language: English
• Published: United States IEEE 01.10.1998
• Subjects: Angiocardiography; Angioplasty; Biomedical applications of radiation; Blood vessels; Brachytherapy; Cardiology; Computer simulation; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - radiotherapy; Dosimetry; Electrocardiography; Female; Histograms; Humans; Image Processing, Computer-Assisted; Image reconstruction; Ionizing radiation; Male; Middle Aged; Radiology; Radiotherapy Dosage; Surface reconstruction; Three dimensional; Ultrasonic imaging; Ultrasonography, Interventional
• ISSN: 0278-0062; 1558-254X
• DOI: 10.1109/42.736033

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 /spl gamma/- and /spl beta/-emitters are used, leading to a wide range of dose distribution over the arterial vessel wall. The authors 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 /spl 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 /spl beta/-irradiation trial (BERT 1.5) conducted in the authors' institution are presented, supporting the use of DVH based on quantitative IVUS measurements for optimal dose prescription in vascular interventional radiation therapy.