Management of Radiotherapy Patients with Implanted Cardiac Devices
D Mihailidis1*, J Prisciandaro2*, (1) Charleston Radiation Therapy Cons, Charleston, WV, (2) University of Michigan, Ann Arbor, MIMO-A-Salon AB-1 Monday 7:30:00 AM - 9:30:00 AM Room: Salon AB
It has been twenty years since the AAPM published TG-34 on cardiac pacemakers of older technology, which has been the standard document for clinical use, even today, for managing patients with pacemakers (ICPs). Management of radiotherapy patients with modern technology cardiac implantable electronic devices (CIEDs) has been widely published in literature without the provision of a new comprehensive and concise set of recommendations. This need is clearly evidenced by the numerous postings on the medical physics list server groups inquiring about advice on dealing with these devices during patient imaging and radiation treatments. As treatment delivery technologies (IMRT, SBRT, dose escalations, proton beams, etc.) and CIED technology advance, the need to address the management of patients with such devices receiving radiation treatment becomes increasingly important. As such, this session will provide updated guidance for caring for radiotherapy patients with CIEDs. Two presentations will be delivered during this session. The first will focus on the work of AAPM TG-203 and provide a summary of the recommendations to the clinical user for management of patients with CIEDs when receiving RT. The second will focus on an institutional experience of managing patients with CIEDs.
1. Review the purpose and function of CIEDs.
2. Provide a review on sources of potential malfunctions of modern CIEDs, including malfunction mechanisms from high-LET radiation and transient effects attributed to medical imaging for radiotherapy.
3. Review the management of radiotherapy patients with cardiac devices.
4. Utilize recently available data and computation methods of out-of-field/peripheral dose by scattered photons and secondary neutrons estimate cumulative doses to CIEDs during treatment. Risk of failure associated with these doses will be discussed.
5. Provide comprehensive recommendations for management of radiotherapy patients with implanted cardiac devices from initial patient consultation to treatment delivery.