{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T03:10:58Z","timestamp":1788491458675,"version":"build-2803163510"},"reference-count":28,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2023,8,11]],"date-time":"2023-08-11T00:00:00Z","timestamp":1691712000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>There has been a recent effort to treat high-risk ventricular tachycardia (VT) patients through radio-ablation. However, manual segmentation of the VT target is complex and time-consuming. This work introduces ASSET, or Auto-segmentation of the Seventeen SEgments for Tachycardia ablation, to aid in radiation therapy (RT) planning. ASSET was retrospectively applied to CTs for 26 thoracic RT patients (13 undergoing VT ablation). The physician-defined parasternal long-axis of the left ventricle (LV) and the axes generated from principal component analysis (PCA) were compared using mean distance to agreement (MDA) and angle of separation. The manually selected right ventricle insertion point and LVs were used to apply the ASSET model to automatically generate the 17 segments of the LV myocardium (LVM). Physician-defined parasternal long-axis differed from PCA by 1.2 \u00b1 0.3 mm MDA and 6.9 \u00b1 0.7 degrees. Segments differed by 0.69 \u00b1 0.29 mm MDA and 0.89 \u00b1 0.03 Dice similarity coefficient. Running ASSET takes &lt;5 min where manual segmentation took &gt;2 h\/patient. Agreement between ASSET and expert contours was comparable to inter-observer variability. Qualitative scoring conducted by three experts revealed automatically generated segmentations were clinically useable as-is. ASSET offers efficient and reliable automatic segmentations for the 17 segments of the LVM for target generation in RT planning.<\/jats:p>","DOI":"10.3390\/cancers15164062","type":"journal-article","created":{"date-parts":[[2023,8,11]],"date-time":"2023-08-11T10:33:23Z","timestamp":1691750003000},"page":"4062","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["ASSET: Auto-Segmentation of the Seventeen SEgments for Ventricular Tachycardia Ablation in Radiation Therapy"],"prefix":"10.3390","volume":"15","author":[{"given":"Eric","family":"Morris","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Washington University, St. Louis, MO 63110, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Chin","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, UCLA Health, Los Angeles, CA 90095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trudy","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, UCLA Health, Los Angeles, CA 90095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clayton","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, UCLA Health, Los Angeles, CA 90095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siamak","family":"Nejad-Davarani","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL 33136, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minsong","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, UCLA Health, Los Angeles, CA 90095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.radonc.2020.01.008","article-title":"First magnetic resonance imaging-guided cardiac radioablation of sustained ventricular tachycardia","volume":"152","author":"Mayinger","year":"2020","journal-title":"Radiother. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e392","DOI":"10.1161\/CIR.0000000000000550","article-title":"Systematic review for the 2017 AHA\/ACC\/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society","volume":"138","author":"Kusumoto","year":"2018","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1161\/CIRCULATIONAHA.113.003063","article-title":"Outcomes in Catheter Ablation of Ventricular Tachycardia in Dilated Nonischemic Cardiomyopathy Compared with Ischemic Cardiomyopathy","volume":"129","author":"Dinov","year":"2014","journal-title":"Circulation"},{"key":"ref_4","first-page":"56","article-title":"Radiofrequency ablation: A review of current knowledge, therapeutic perspectives, complications, and contraindications","volume":"4","author":"Cabrera","year":"2018","journal-title":"Int. J. Biosens. Bioelectron."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2325","DOI":"10.1056\/NEJMoa1613773","article-title":"Noninvasive Cardiac Radiation for Ablation of Ventricular Tachycardia","volume":"377","author":"Cuculich","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_6","first-page":"e705","article-title":"Treatment Planning Considerations for Robotic Guided Cardiac Radiosurgery for Atrial Fibrillation","volume":"8","author":"Blanck","year":"2016","journal-title":"Cureus"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1016\/j.prro.2019.02.003","article-title":"Lessons Learned from the First Human Low-Field MRI Guided Radiation Therapy of the Heart in the Presence of an Implantable Cardiac Defibrillator","volume":"9","author":"Gach","year":"2019","journal-title":"Pract. Radiat. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1007\/s10840-020-00849-0","article-title":"Non-invasive stereotactic body radiation therapy for refractory ventricular arrhythmias: An institutional experience","volume":"61","author":"Chin","year":"2020","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1161\/CIRCULATIONAHA.118.038261","article-title":"Phase I\/II trial of electrophysiology-guided noninvasive cardiac radioablation for ventricular tachycardia","volume":"139","author":"Robinson","year":"2019","journal-title":"Circulation"},{"key":"ref_10","first-page":"1088","article-title":"Stereotactic radiosurgery for ablation of ventricular tachycardia","volume":"21","author":"Neuwirth","year":"2019","journal-title":"EP Eur."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"American Heart Association Writing Group on Myocardial Segmentation, Imaging R for C, Cerqueira, M.D., Weissman, N.J., Dilsizian, V., Jacobs, A.K., Kaul, S., Laskey, W.K., Pennell, D.J., Rumberger, J.A., and Ryan, T. (2002). Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation, 105, 539\u2013542.","DOI":"10.1161\/hc0402.102975"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1093\/eurheartj\/16.suppl_J.2","article-title":"The multicentre trial philosophy in stress echocardiography: Lessons learned fom the EPIC study","volume":"16","author":"Picano","year":"1995","journal-title":"Eur. Heart J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1148\/radiol.13130942","article-title":"Improved Late Gadolinium Enhancement MR Imaging for Patients with Implanted Cardiac Devices","volume":"270","author":"Rashid","year":"2014","journal-title":"Radiology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1161\/CIRCIMAGING.112.973560","article-title":"Normal Left Ventricular Myocardial Thickness for Middle-Aged and Older Subjects with Steady-State Free Precession Cardiac Magnetic Resonance","volume":"5","author":"Kawel","year":"2012","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1016\/j.jcmg.2017.09.010","article-title":"Definition of Left Ventricular Segments for Cardiac Magnetic Resonance Imaging","volume":"11","author":"Selvadurai","year":"2017","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.ijrobp.2021.03.051","article-title":"Method and Atlas to Enable Targeting for Cardiac Radioablation Employing the American Heart Association Segmented Model","volume":"111","author":"Brownstein","year":"2021","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Picano, E. (2003). Stress Echocardiography, Springer.","DOI":"10.1007\/978-3-662-05096-5"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Jolliffe, I.T. (1986). Principal Component Analysis, Springer. Springer Series in Statistics.","DOI":"10.1007\/978-1-4757-1904-8"},{"key":"ref_19","unstructured":"Hedberg, H., Kristensen, F., Nilsson, P., and Owall, V. (2005, January 23\u201326). A low complexity architecture for binary image erosion and dilation using structuring element decomposition. Proceedings of the 2005 IEEE International Symposium on Circuits and Systems, Kobe, Japan."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"121712","DOI":"10.1118\/1.4901409","article-title":"Deformable image registration based automatic CT-to-CT contour propagation for head and neck adaptive radiotherapy in the routine clinical setting","volume":"41","author":"Kumarasiri","year":"2014","journal-title":"Med. Phys."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1016\/j.ijrobp.2018.11.025","article-title":"Cardiac Substructure Segmentation and Dosimetry Using a Novel Hybrid Magnetic Resonance and Computed Tomography Cardiac Atlas","volume":"103","author":"Morris","year":"2019","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1002\/mp.13940","article-title":"Cardiac substructure segmentation with deep learning for improved cardiac sparing","volume":"47","author":"Morris","year":"2020","journal-title":"Med. Phys."},{"key":"ref_23","unstructured":"Mortazi, A., Burt, J., and Bagci, U. (2017). International Workshop on Statistical Atlases and Computational Models of the Heart, Springer."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.media.2016.01.005","article-title":"A combined deep-learning and deformable-model approach to fully automatic segmentation of the left ventricle in cardiac MRI","volume":"30","author":"Avendi","year":"2016","journal-title":"Med. Image Anal."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.radonc.2016.11.016","article-title":"Cardiac atlas development and validation for automatic segmentation of cardiac substructures","volume":"122","author":"Zhou","year":"2017","journal-title":"Radiother. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"128","DOI":"10.15420\/aer.2013.2.2.128","article-title":"Imaging-guided Ventricular Tachycardia Ablation","volume":"2","author":"Piers","year":"2013","journal-title":"Arrhythm. Electrophysiol. Rev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"050902","DOI":"10.1118\/1.4871620","article-title":"Vision 20\/20: Perspectives on automated image segmentation for radiotherapy","volume":"41","author":"Sharp","year":"2014","journal-title":"Med. Phys."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"100406","DOI":"10.1016\/j.phro.2022.12.003","article-title":"Quality assurance process within the RAdiosurgery for VENtricular TAchycardia (RAVENTA) trial for the fusion of electroanatomical mapping and radiotherapy planning imaging data in cardiac radioablation","volume":"25","author":"Mayinger","year":"2023","journal-title":"Phys. Imaging Radiat. Oncol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/15\/16\/4062\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:31:31Z","timestamp":1760128291000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/15\/16\/4062"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,11]]},"references-count":28,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["cancers15164062"],"URL":"https:\/\/doi.org\/10.3390\/cancers15164062","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,11]]}}}