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Implanted Electronic Device Management in a Pencil-Beam Scanning Proton-Therapy Clinic
Mark D Pepin1, Brooke E Ball1, Lynette G Stuart-Mullen2
1Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
Practical Radiation Oncology
|April 5, 2026
Summary
Proton therapy can be safely administered to patients with implanted electronic devices (IEDs) by implementing specific risk-based guidelines and monitoring protocols. This approach minimizes device interference and ensures patient safety during treatment.
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.
