WE-G-218-02: The Measurement of Absorbed Dose to Active Intravenous Cardiac Devices in Patients Undergoing...

Radiotherapy departments are seeing an increasing number of patients presenting for treatment with active intravenous cardiac devices (AICDs). This is due to an increasing aging population and technology advances in these devices. The AAPM TG-34 addressed the radiation effects in these devices and provided recommendations for patients with these devices undergoing radiotherapy. The current devices utilizing CMOS technology are more sensitive to radiation then the older bipolar devices. Therefore, it is important to estimate the dose to the device to ensure that the radiation does not adversely affect the performance of the device. This is particularly important for patients dependent on their accurate functioning. The dose to the device is generally from secondary radiation and is typically below 0.05 Gy with most of it coming from lower energy scatter radiation. Treatment planning systems can be used to estimate the dose to the device. However, these systems do not accurately calculate doses at distances more than 2-3 cm from the field edge. For these out-of-field dose measurements the dosimeter requires a high sensitivity and a relatively flat energy response. Thermoluminescent detectors and optically stimulated luminescent detectors satisfy these requirements and they are relatively unobtrusive. The newer formulations of radiochromic film with higher sensitivity can also be used. The detector should be place under 0.5 to 1.0 cm of bolus to minimize the contaminating head-scatter electrons provide a more realistic measurement of the dose to the device.

1. List the reasons for estimating the dose to the AICDs 2. Provide a discussion on the various methods which include calculations and measurements to estimate the dose to the device as well as the uncertainties in these estimates. 3. Identify detectors that satisfy the requirements for these in-vivo out-of-field dose measurements as well as describe the appropriate correction factors to apply for accurate dose measurements.