Extended Reality Simulator for Dynamic Visualization and Evaluation of Stereotactic Arrhythmia Radioablation (STAR) Treatment Plans within RAVENTA Trial

Stereotactic Arrhythmia Radioablation (STAR) represents an emerging non-invasive treatment for therapy-refractory ventricular tachycardia. Yet, its planning workflow remains challenged by the integration of multimodal cardiac imaging, the transfer of electroanatomical mapping
(EAM) information, and the impact of cardio-respiratory motion on dose delivery. Current radiotherapy (RT) planning systems offer only static visualization and provide limited access to intramural myocardial structures, hindering interdisciplinary communication between cardiology and radiation oncology teams. We present a novel extended reality (XR) platform designed to unify and dynamically visualize STAR-relevant imaging and planning data. The system integrates diastolic cardiac CT, respiratory-binned 4D CT, anatomical segmentations, EAM data, and phase-recomputed RT dose distributions within an XR environment. Through deformable registration, heart structures and dose volumes are propagated across respiratory phases, enabling phase-specific inspection of dose conformality on both radiotherapy planning target volumes (PTV) and intramural cardiac target volumes (CardTV). ... mehrThe resulting time-resolved volumetric dataset is rendered in an XR interface, allowing cardiology and radiation oncology clinicians to explore cardiac motion, visualize intramural dose deposition, and jointly assess target and organat-risk dynamics, supporting qualitative evaluation of dose-motion interplay and interdisciplinary interpretation of complex intramural targets.
The system was tested on three STAR patients enrolled in the RAVENTA trial. Motion analysis revealed isocenter displacements over the breathing cycle of up to 17.5mm, 10.2mm, and 8.9mm for patients 1, 2, and 3, respectively, resulting in conformity index variations of 0.38,
0.34, and 0.19. This proof-of-concept demonstrates the feasibility and potential clinical value of XR-based motion-aware dose visualization for STAR planning.