Cardiac segmentation for ventricular tachycardia radioablation and radiotherapy patients with cardiac implants
Abstract
Deep-learning (DL) segmentation enables cardiac substructure (CS) delineation for advanced cardiac-sparing radiation therapy (RT). Patients presenting for RT may have implantable devices (cardioverter-defibrillators (ICDs)) and metal artifacts. Stereotactic body RT (SBRT) is used to treat ventricular tachycardia (VT), a population frequently with ICDs. We apply a DL model for RT patients with ICDs or undergoing VT-SBRT, enabling segmentation and CS-level dose analysis. CT simulation (CT-SIM) of 19 patients with ICDs and received VT-SBRT were evaluated. A validated segmentation model was retrained using a highly-curated CT-SIM cohort, supplemented with ICD images for training and validation, with a hold-out ICD test set (n=10), to predict 20 CS. Additional CT-SIM datasets included cancer-RT patients with (n=9) and without (n=10) ICDs to evaluate generalizability. The retrained ICD-supplemented model was compared against a non-ICD model using Dice similarity coefficient (DSC), 95% Hausdorff distance (HD95), and Wilcoxon signed-rank test (p<0.05). Dosimetric evaluation was performed for VT-SBRT CS. For VT-SBRT, the ICD-supplemented model achieved average DSC/HD95 of 0.71(0.19)/10.7(22.5)mm respectively, outperforming (p<0.05) the non-ICD model. On CT-SIM with ICDs, average DSC/HD95 were 0.70(0.22)/7.9(5.1)mm respectively, outperforming (p<0.05) the non-ICD model. On CT-SIM without ICDs, the average DSC was 0.74(0.17) (Non-ICD, DSC, 0.75(0.16), p<0.05) and average HD95 was 5.5(3.1)mm (Non-ICD, HD95, 5.3(2.8mm)). For VT-SBRT, CS dose depended on target location, with higher relative dose delivered to the ventricles, tricuspid valve, atrioventricular node, and left coronary arteries than other CS. ICD-supplemented training improved CS segmentation despite metal artifacts without meaningfully degrading non-ICD performance, supporting segmentation and CS-level dosimetry in ICD populations.
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BibTeX
@misc{summerfield2026cardiac,
title = {{Cardiac segmentation for ventricular tachycardia radioablation and radiotherapy patients with cardiac implants}},
author = {Nicholas Summerfield and Dustin Jacqmin and Chase Ruff and Andrew M. Baschnagel and Adam Burr and Michael Bassetti and Ryan Kipp and Matthew Kalscheur and Patrick M. Hill and Ming Dong and Carri Glide-Hurst},
howpublished = {arXiv},
year = {2026},
month = sep,
doi = {10.48550/arxiv.2609.36367},
eprint = {2609.36367},
archivePrefix = {arXiv},
url = {https://arxiv.org/abs/2609.36367},
note = {CC BY 4.0},
}
RIS
TY - UNPB
TI - Cardiac segmentation for ventricular tachycardia radioablation and radiotherapy patients with cardiac implants
AU - Nicholas Summerfield
AU - Dustin Jacqmin
AU - Chase Ruff
AU - Andrew M. Baschnagel
AU - Adam Burr
AU - Michael Bassetti
AU - Ryan Kipp
AU - Matthew Kalscheur
AU - Patrick M. Hill
AU - Ming Dong
AU - Carri Glide-Hurst
PY - 2026
DA - 2026/09/28
PB - arXiv
DO - 10.48550/arxiv.2609.36367
UR - https://arxiv.org/abs/2609.36367
AB - Deep-learning (DL) segmentation enables cardiac substructure (CS) delineation for advanced cardiac-sparing radiation therapy (RT). Patients presenting for RT may have implantable devices (cardioverter-defibrillators (ICDs)) and metal artifacts. Stereotactic body RT (SBRT) is used to treat ventricular tachycardia (VT), a population frequently with ICDs. We apply a DL model for RT patients with ICDs or undergoing VT-SBRT, enabling segmentation and CS-level dose analysis. CT simulation (CT-SIM) of 19 patients with ICDs and received VT-SBRT were evaluated. A validated segmentation model was retrained using a highly-curated CT-SIM cohort, supplemented with ICD images for training and validation, with a hold-out ICD test set (n=10), to predict 20 CS. Additional CT-SIM datasets included cancer-RT patients with (n=9) and without (n=10) ICDs to evaluate generalizability. The retrained ICD-supplemented model was compared against a non-ICD model using Dice similarity coefficient (DSC), 95% Hausdorff distance (HD95), and Wilcoxon signed-rank test (p<0.05). Dosimetric evaluation was performed for VT-SBRT CS. For VT-SBRT, the ICD-supplemented model achieved average DSC/HD95 of 0.71(0.19)/10.7(22.5)mm respectively, outperforming (p<0.05) the non-ICD model. On CT-SIM with ICDs, average DSC/HD95 were 0.70(0.22)/7.9(5.1)mm respectively, outperforming (p<0.05) the non-ICD model. On CT-SIM without ICDs, the average DSC was 0.74(0.17) (Non-ICD, DSC, 0.75(0.16), p<0.05) and average HD95 was 5.5(3.1)mm (Non-ICD, HD95, 5.3(2.8mm)). For VT-SBRT, CS dose depended on target location, with higher relative dose delivered to the ventricles, tricuspid valve, atrioventricular node, and left coronary arteries than other CS. ICD-supplemented training improved CS segmentation despite metal artifacts without meaningfully degrading non-ICD performance, supporting segmentation and CS-level dosimetry in ICD populations.
ER -