WE-G-218-01: Management of RT Patients with Implanted Cardiac Devices: Updated Recommendations?

Area of Science:

• Medical Physics
• Radiation Oncology
• Biomedical Engineering

Background:

• Older AAPM TG-34 guidelines are outdated for modern pacemakers (ICPs) and implantable cardioverter-defibrillators (ICDs).
• Recent advancements in radiation therapy technologies and CIEDs necessitate updated management recommendations.
• Clinical inquiries regarding patient management during imaging and radiation treatments highlight the need for comprehensive guidance.

Purpose of the Study:

• Review potential malfunctions of modern ICPs and ICDs due to radiation exposure.
• Assess cumulative doses to CIEDs from scattered photons and secondary neutrons during various radiotherapy techniques.
• Provide updated recommendations for managing patients with CIEDs throughout radiotherapy, from evaluation to post-treatment assessment.

Main Methods:

• Literature review on radiation effects on CIEDs.
• Analysis of out-of-field/peripheral dose calculations using recent data and computational methods.
• Development of management protocols for radiotherapy patients with CIEDs.

Main Results:

• Identified sources of potential CIED malfunctions from high-LET radiations and medical imaging procedures.
• Quantified cumulative doses to CIEDs during Intensity-Modulated Radiation Therapy (IMRT), Stereotactic Body Radiation Therapy (SBRT), and proton beam therapy.
• Highlighted discrepancies in current manufacturer recommendations and facility protocols.

Conclusions:

• Established the critical need for updated AAPM guidelines (TG-203) for managing patients with CIEDs during radiation therapy.
• Provided a framework for dosimetric evaluation and risk assessment of CIEDs in radiation oncology.
• Emphasized the importance of standardized protocols for patient evaluation, treatment planning, and device integrity checks post-therapy.