| Question 1: Regarding radiotherapy dose limits to implantable cardiac pacemakers (ICPs) and implantable cardiac defibrillators (ICDs), cardiac implantable electronic device (CIED) vendors: |
| Reference: | Miften, M. et al., “Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG-203,” Medical Physics, 46(12): e757-e788; 2019. |
| Choice A: | Agree that ICPs and ICDs should receive a cumulative dose not greater than 2 Gy. |
| Choice B: | Agree that ICPs and ICDs should receive a cumulative dose not greater than 5 Gy. |
| Choice C: | Agree that ICPs and ICDs should receive a cumulative dose not greater than 2 Gy and 1 Gy,respectively. |
| Choice D: | Do not have consistent recommendations. |
| Question 2: Unlike implantable cardiac pacemakers (ICPs), modern implantable cardiac defibrillators (ICDs): |
| Reference: | Miften, M. et al., “Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG-203,” Medical Physics, 46(12): e757-e788; 2019. https://www.heart.org/en/health-topics/arrhythmia/prevention--treatment-of-arrhythmia/implantable- cardioverter-defibrillator-icd |
| Choice A: | Maintain cardiac rhythms |
| Choice B: | Correct life-threatening arrhythmias |
| Choice C: | Monitor the heart’s rhythms |
| Choice D: | Coordinate the chambers of the heart |
| Question 3: A more rigorous determination of the expected dose on a CIED is appropriate when: |
| Reference: | Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG-203,” M. Miften, D. Mihailidis, S F. Kry, et al. Med. Phys. 46, e757-e788 (2019). |
| Choice A: | The device is located >10 cm from the photon treatment field edge. |
| Choice B: | The device is located >10 cm from the photon treatment isocenter. |
| Choice C: | The device is located <10 cm from the photon treatment isocenter. |
| Choice D: | The device is located <10 cm from the photon treatment field edge. |
| Question 4: A treatment planning system can be utilized to estimate the maximum and mean doses to the CIED only when: |
| Reference: | Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG-203,” M. Miften, D. Mihailidis, S F. Kry, et al. Med. Phys. 46, e757-e788 (2019). |
| Choice A: | The device is located at 4-11cm from the photon treatment field edge. |
| Choice B: | The device is located < 4 cm from the 5% isodose line of an IMRT plan. |
| Choice C: | The device is located < 3 cm from the photon treatment field. |
| Choice D: | The device is located < 4 cm from the 50% isodose line of an IMRT plan. |
| Question 5: TG-203 and the Heart Rhythm Society recommend the use of low energy photons <= 10 MV for radiotherapy treatments to reduce the risk of: |
| Reference: | Miften, M. et al., “Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG-203,” Medical Physics, 46(12): e757-e788; 2019.
Indik, J.H. et al., “2017 HRS expert consensus statement on magnetic resonance imaging and radiation exposure in patients with cardiovascular implantable electronic devices,” Heart Rhythm, 14(7): e97-e153. |
| Choice A: | Single upset events that result in the loss of stored data or a device reset. |
| Choice B: | Damage to the lead tissue interface causing an increase in the pacing threshold. |
| Choice C: | Transient interference that inhibit pacing or inappropriately administers tachycardia therapy. |
| Choice D: | Permanent damage that result in loss of devices telemetry capabilities. |
| Question 6: AAPM TG-203 recommends the management of a radiotherapy pacing-independent patient receiving a dose of 3 Gy from a 6 MV beam at the location of CIED as: |
| Reference: | Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG-203,” M. Miften, D. Mihailidis, S F. Kry, et al. Med. Phys. 46, e757-e788 (2019). |
| Choice A: | Low risk. |
| Choice B: | Medium risk. |
| Choice C: | High risk. |
| Choice D: | Risk level depends on the patient disease site. |
