# Novel imaging and treatment technologies for image-guided noninvasive stereotactic cardiac radiosurgery

> **NIH NIH R01** · WASHINGTON UNIVERSITY · 2022 · $414,493

## Abstract

Abstract
 Sudden cardiac death (SCD) caused by ventricular tachycardia (VT) results in >150,000 deaths/year
in the U.S. Noninvasive Stereotactic Cardiac Radiosurgery (NSCR) was recently reported as a novel and
alternative noninvasive treatment option to treat VT refractory to standard drug and catheter ablation
therapy (Cuculich and Robinson, NEJM, Dec. 2017). The initial results for five patients resulted in a 99.9%
reduction of VT episodes after 6 weeks, leading to a Phase I/II clinical trial in 2016-2018
(ClinicalTrials.gov NCT02919618). The preliminary results of Phase I/II trial showed similar efficacy
(publication is pending) to the initial pilot study. Currently, the target volume is ~3 times larger than the
arrhythmogenic tissue to ensure the therapeutic dose is delivered to the cardiac lesion in the presence of
cardiac and respiratory motion. Despite evidence supporting efficacy, it is essential to minimize the
volume of healthy cardiac tissue unnecessarily treated to high radiation doses to reduce the likelihood of
late complications (including pericarditis, angina, myocardial infarction and accelerated atherosclerosis).
Our clinical goals of this study are to: 1) Improve the accuracy of directing the radiation beam to the
diseased myocardial tissue; 2) Reduce radiation toxicity to the surrounding healthy tissues of the heart,
lungs and esophagus; and 3) Improve the overall NSCR treatment efficacy. These goals will be
accomplished using novel radiation treatment processes, target definition, imaging, image guidance,
target motion tracking and prediction, and radiation delivery gating methods. New MRI and cone beam
CT (CBCT) image acquisition and reconstruction methods will be developed to characterize and
compensate for cardiac and respiratory motion, and to dramatically improve target definition and motion
management components of NSCR. New NSCR treatment processes will be developed to reduce the
patient setup uncertainties on the treatment day, and to improve the radiation delivery accuracy by
tracking the target motion and gating the radiation beam based on the real-time target position and the
respiratory + ECG signals. The new treatment and imaging methods developed and tested under this
study will be applicable to both MRI-guided radiation delivery systems (MR-Linacs) and CBCT image
guided radiation delivery systems (CBCT-Linacs).

## Key facts

- **NIH application ID:** 10463571
- **Project number:** 5R01HL148210-04
- **Recipient organization:** WASHINGTON UNIVERSITY
- **Principal Investigator:** H MICHAEL GACH
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $414,493
- **Award type:** 5
- **Project period:** 2019-08-17 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10463571

## Citation

> US National Institutes of Health, RePORTER application 10463571, Novel imaging and treatment technologies for image-guided noninvasive stereotactic cardiac radiosurgery (5R01HL148210-04). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10463571. Licensed CC0.

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