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Management of Radiotherapy Patients with Cardiac Implantable Electronic Devices

D Mihailidis

S Kry

M Miften

D Mihailidis1*, S Kry2*, M Miften3*, (1) University of Pennsylvania, Philadelphia, PA, (2) MD Anderson Cancer Center, Houston, TX, (3) University of Colorado School of Medicine, Aurora, CO


11:15 AM : Potential sources of malfunction of CIEDs in a radiotherapy environment - D Mihailidis, Presenting Author
11:35 AM : Assessing the risk of CIED malfunction from radiation - S Kry, Presenting Author
11:55 AM : How to manage radiotherapy patients with CIED from initial consult to treatment: TG203 recommendations - M Miften, Presenting Author

WE-E-201-0 (Wednesday, August 2, 2017) 11:15 AM - 12:15 PM Room: 201

Management of RT patients with Cardiac Implantable Electronic Devices (CIED) is essential. As more patients with CIEDs are receiving radiation treatments, assessing the risk of radiation exposure to CIED demands better understanding of the sources of potential malfunction arising from RT treatments. The need for comprehensive and concise set of recommendations 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. Safe medical practice requires that the risk to patients is reduced as much as possible. AAPM TG-203 has been focused on devising recommendations for the management of patients from simulation to post irradiation follow-up with a special emphasis on reducing potential damage to CIEDs. The main focus of this educational session is to improve the medical physics community knowledge base on the risk to CIED from imaging and RT procedures and provide a summary of TG-203 recommendations on the management of patients with CIEDs receiving RT.

Learning Objectives:
1. Review the function of cardiac pacemakers and defibrillators and discuss sources of potential malfunctions of cardiac pacemakers and defibrillators, including malfunction mechanisms from high-LET radiations and transient effects attributed to medical imaging and RT procedures.
2. Utilize recently available data and computation methods of out-of-field/peripheral dose by scattered photons and secondary neutrons to estimate cumulative doses to CIEDs during treatment. Risk of failure associated with these doses will be discussed.
3. Provide TG-203 recommendations for management of radiotherapy patients with implanted cardiac devices from initial patient consultation to treatment delivery.


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