A pulmonary vein atlas for radiotherapy planning

Gerard M Walls*, Conor McCann, Peter Ball, Katelyn M Atkins, Raymond H Mak, Ahmed Bedair, Jolyne O'Hare, Jonathan McAleese, Claire Harrison, Karen A Tumelty, Cathryn Crockett, Sarah-Louise Black, Catherine Nelson, John O'Connor, Alan R Hounsell, Conor K McGarry, Karl T Butterworth, Aidan J Cole, Suneil Jain, Gerard G Hanna

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

19 Downloads (Pure)


Background and Purpose
Cardiac arrhythmia is a recognised potential complication of thoracic radiotherapy, but the responsible cardiac substructures for arrhythmogenesis have not been identified. Arrhythmogenic tissue is commonly located in the pulmonary veins (PVs) of cardiology patients with arrhythmia, however these structures are not currently considered organs-at-risk during radiotherapy planning. A standardised approach to their delineation was developed and evaluated.

Materials and Methods
The gross and radiological anatomy relevant to atrial fibrillation was derived from cardiology and radiology literature by a multidisciplinary team. A region of interest and contouring instructions for radiotherapy computed tomography scans were iteratively developed and subsequently evaluated. Radiation oncologists (n = 5) and radiation technologists (n = 2) contoured the PVs on the four-dimensional planning datasets of five patients with locally advanced lung cancer treated with 1.8–2.75 Gy fractions. Contours were compared to reference contours agreed by the researchers using geometric and dosimetric parameters.

The mean dose to the PVs was 35% prescription dose. Geometric and dosimetric similarity of the observer contours with reference contours was fair, with an overall mean Dice of 0.80 ± 0.02. The right superior PV (mean DSC 0.83 ± 0.02) had better overlap than the left (mean DSC 0.80 ± 0.03), but the inferior PVs were equivalent (mean DSC of 0.78). The mean difference in mean dose was 0.79 Gy ± 0.71 (1.46% ± 1.25).

A PV atlas with multidisciplinary approval led to reproducible delineation for radiotherapy planning, supporting the utility of the atlas in future clinical radiotherapy cardiotoxicity research encompassing arrhythmia endpoints.

Original languageEnglish
Article number109680
Number of pages9
JournalRadiotherapy and Oncology
Early online date15 May 2023
Publication statusPublished - Jul 2023


Dive into the research topics of 'A pulmonary vein atlas for radiotherapy planning'. Together they form a unique fingerprint.

Cite this