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Area of Science:

  • Oncology
  • Medical Physics
  • Cardiology

Background:

  • High-volume proton therapy clinics present unique challenges for patients with implanted electronic devices (IEDs).
  • Potential risks include neutron damage and device malfunction, necessitating careful management strategies.

Purpose of the Study:

  • To present single-institution workflows and experience in treating patients with IEDs at a proton pencil-beam scanning clinic.
  • To establish safe and effective management protocols for patients with cardiac (CIEDs) and medical IEDs (MIEDs) undergoing proton radiotherapy.

Main Methods:

  • A multidisciplinary team assessed risks associated with IEDs during proton therapy.
  • Developed a comprehensive policy for managing CIEDs and MIEDs, including endocrinology devices, neurostimulators, auditory-assist devices, and infusion pumps.
  • Implemented a workflow for device identification and risk mitigation at key treatment stages.

Main Results:

  • 294 proton radiotherapy courses were delivered to patients with IEDs.
  • 144 courses for CIED patients included heart rate monitoring and device interrogations.
  • Five CIED patients experienced recoverable resets, with no major device failures reported.

Conclusions:

  • Risk-based guidelines were successfully developed and refined.
  • These guidelines enable the safe treatment of patients with CIEDs and MIEDs using proton therapy.