Current Practice for Electronic Medical Device Management in Radiation Therapy

Electronic medical devices (EMDs) must be carefully managed in radiation oncology to prevent radiation-induced malfunction. Only one EMD, cardiovascular implantable electronic devices (CIEDs), currently has a recommended protocol for clinical management. This international survey aims to improve understanding of the current state of EMD management for CIEDs and six other EMDs. Characterizing the current state of EMD management is a crucial step towards the development of additional protocols.

This survey was distributed to more than 2500 physicists via email. The survey consisted of multiple-choice, short-answer, and matrix-style questions addressing many topics, including the desire for guidance, frequency of EMD observance, existence of current policies, documentation and training regarding current policies, allowance of devices in primary beams, discouragement of neutron-producing energies and hypofractionation, estimation of cumulative dose, access to specialists for consultation, and difficulties experienced in implementing current protocols.

A total of 258 completed responses were collected representing a variety of clinical perspectives. Responses demonstrated a community desire for additional guidance, with 69% of respondents indicating that their clinic would benefit from additional guidance regarding six non-CIED devices. A lack of institutional policies was also observed for these devices, with 73% of respondents indicating that their clinic lacks institutional policies. Among the policies that do exist for these devices there is considerable variability.

This study demonstrates both a need and a desire for additional guidance regarding the clinical management of patients with EMDs in radiotherapy. This desire is reflected in the lack of institutional policies addressing EMDs and the variability among the policies that do exist.