A systematic review of non-cardiac implantable electronic devices malfunctions in radiation therapy

The number of patients carrying implantable devices (IEDs) in radiotherapy is increasing. While the effects of radiation on cardiac IEDs are well documented, little has been written on non-cardiac IED (NC-IED). This study aims to collect and analyze current evidence on the effects of ionizing radiation on NC-IEDs.

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search (January 2003-June 2025) was performed across four databases, focusing on cochlear implants, implantable pumps, and neurostimulators exposed to radiation. Reported malfunctions were analyzed according to device type, irradiation conditions (primary vs. scattered radiation), beam energy (neutron- vs. non-neutron-producing), and dose. Fisher's exact test was used to assess correlations between these parameters and device malfunctions. Authors' and manufacturers' recommendations for managing patients with NC-IEDs during radiotherapy were also collected.

Twenty-seven articles were identified, mostly case reports (16). 184 devices were irradiated, with 27% exposed to the primary beam (mainly in vitro studies) and 73% to scattered radiation (all in vivo). Overall rate of malfunctions was 5.4% (10 NC-IEDs): 4.9% under the primary beam and 0.5% under scattered radiation (p < 0.01). Neutron-producing energies were used in seven studies, with malfunction rates of 6.8% at ≥10 MV and 6.6% at <10 MV (p > 0.01). Manufacturers warn that ionising radiation can damage the device and suggest avoiding direct irradiation.

Although the available literature is limited, NC-IEDs appear to be relatively robust to radiation exposure when kept outside the primary beam.