Build 5DCT by Connecting Cardiac ECG 4DCT with Respiratory 4DCT for Heart Motion Management in Stereotactic Tachycardia Radiosurgery

Purpose: To develop a generic procedure to make 5DCT from ECG 4DCTs and respiratory 4DCTs of cardiac RT patients. The 5DCT, whose dimension consists of 3D volume, cardiac cycle and respiratory cycle, will be used for quantitatively evaluating respiratory and cardiac motion of the heart, and supporting cardiac RT motion management, 5D dose calculation and dosimetry motion assessment. Methods: Images of ECG 4DCTs and respiratory 4DCTs for cardiac RT patients were obtained from the clinical system with IRB approval. For each patient, ten ECG 4DCT phases were registered using the groupwise deformable image registration algorithm GroupRegNet. The results were the template ECG CT representing the accurate average heart anatomy rather than an intensity-averaged CT, and the cardiac 4D DVF (deformation vector field). The ECG CT template and ten respiratory 4DCT phases were registered together using the 2nd groupwise registration to compute the 2nd respiratory 4D DVF. The computed DVFs from two groupwise registrations connected ECG 4DCTs to respiratory 4DCTs. A 10x10 cardiorespiratory 5DCT volume was generated by warping the ECG phases using composed DVFs. The final 5DCT phases were manually evaluated by visually the checking the respiratory and cardiac motion of the heart chambers. Results: The 5DCT generation procedure was implemented using Python and MATLAB, and was successfully applied to 4DCT images from five cardiac RT patients. The registration results were satisfactory based on visual evaluation. The quantitative evaluation and 5D dose calculation are planned for future work. Conclusion: A practical and effective procedure was developed to assess 5D motion of the heart and generate 5DCT phases from the clinical ECG 4DCTs and respiratory 4DCTs. The generated 5DCT could be used in dose calculation to assess the effect of 5D motion of the heart chambers on dosimetry for cardiac RT treatments.