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Gupta A, Glein R, Hossain N, Sundhu M, Rotondo R, Sheldon SH, Noheria A. Safety of particle radiotherapy in patients with cardiac implantable electronic devices: Review of literature. Pacing Clin Electrophysiol 2024. [PMID: 39119850 DOI: 10.1111/pace.15050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/14/2024] [Accepted: 07/18/2024] [Indexed: 08/10/2024]
Affiliation(s)
- Amulya Gupta
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Rachel Glein
- The University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Nabil Hossain
- The University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Murtaza Sundhu
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Ronny Rotondo
- Department of Radiation Oncology, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Seth H Sheldon
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Amit Noheria
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
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Mircea AA, Donisan T, Feigenberg S, Fradley MG. What do national radiotherapy guidelines for patients with cardiac devices teach us? Heart Rhythm O2 2024; 5:189-193. [PMID: 38560371 PMCID: PMC10980919 DOI: 10.1016/j.hroo.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
The incidence of cardiac implantable electronic device (CIED) malfunctions caused by radiotherapy (RT) is approximately 5%. Although individual national guidelines and expert consensus documents exist, the increased use of RT to treat various cancers points out the need for a standardized document to guide risk assessment and management of CIEDs during RT. We describe potential adverse RT-related events on CIEDs as well as the proposed mechanism of dysfunction. We review the main current guidelines and recommendations, emphasizing similarities and differences.
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Affiliation(s)
- Andrei Alexandru Mircea
- Electrophysiology and Heart Modeling Institute, Heart Rhythm Disease Institute, Bordeaux, France
| | - Teodora Donisan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Steven Feigenberg
- Radiation Oncology Department, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael G. Fradley
- Thalheimer Center for Cardio-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
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Lisowski D, Lutyj P, Abazari A, Weick S, Traub J, Polat B, Flentje M, Kraft J. Impact of Radiotherapy on Malfunctions and Battery Life of Cardiac Implantable Electronic Devices in Cancer Patients. Cancers (Basel) 2023; 15:4830. [PMID: 37835524 PMCID: PMC10571836 DOI: 10.3390/cancers15194830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023] Open
Abstract
PURPOSE This study analyses a large number of cancer patients with CIEDs for device malfunction and premature battery depletion by device interrogation after each radiotherapy fraction and compares different guidelines in regard to patient safety. METHODS From 2007 to 2022, a cohort of 255 patients was analyzed for CIED malfunctions via immediate device interrogation after every RT fraction. RESULTS Out of 324 series of radiotherapy treatments, with a total number of 5742 CIED interrogations, nine device malfunctions (2.8%) occurred. Switching into back-up/safety mode and software errors occurred four times each. Once, automatic read-out could not be performed. The median prescribed cumulative dose at planning target volume (PTV) associated with CIED malfunction was 45.0 Gy (IQR 36.0-64.0 Gy), with a median dose per fraction of 2.31 Gy (IQR 2.0-3.0 Gy). The median maximum dose at the CIED at time of malfunction was 0.3 Gy (IQR 0.0-1.3 Gy). No correlation between CIED malfunction and maximum photon energy (p = 0.07), maximum dose at the CIED (p = 0.59) nor treatment localization (p = 0.41) could be detected. After excluding the nine malfunctions, premature battery depletion was only observed three times (1.2%). Depending on the national guidelines, 1-9 CIED malfunctions in this study would have been detected on the day of occurrence and in none of the cases would patient safety have been compromised. CONCLUSION Radiation-induced malfunctions of CIEDs and premature battery depletion are rare. If recommendations of national safety guidelines are followed, only a portion of the malfunctions would be detected directly after occurrence. Nevertheless, patient safety would not be compromised.
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Affiliation(s)
- Dominik Lisowski
- Department of Radiation Oncology, University Hospital Würzburg, 97080 Würzburg, Germany (J.K.)
| | - Paul Lutyj
- Department of Radiation Oncology, University Hospital Würzburg, 97080 Würzburg, Germany (J.K.)
| | - Arya Abazari
- Department of Radiation Oncology, University Hospital Würzburg, 97080 Würzburg, Germany (J.K.)
| | - Stefan Weick
- Department of Radiation Oncology, University Hospital Würzburg, 97080 Würzburg, Germany (J.K.)
| | - Jan Traub
- Department of Internal Medicine I, Division of Cardiology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Bülent Polat
- Department of Radiation Oncology, University Hospital Würzburg, 97080 Würzburg, Germany (J.K.)
| | - Michael Flentje
- Department of Radiation Oncology, University Hospital Würzburg, 97080 Würzburg, Germany (J.K.)
| | - Johannes Kraft
- Department of Radiation Oncology, University Hospital Würzburg, 97080 Würzburg, Germany (J.K.)
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Mirzaei M, Rowshanfarzad P, Gill S, Ebert MA, Dass J. Risk of cardiac implantable device malfunction in cancer patients receiving proton therapy: an overview. Front Oncol 2023; 13:1181450. [PMID: 37469405 PMCID: PMC10352826 DOI: 10.3389/fonc.2023.1181450] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/12/2023] [Indexed: 07/21/2023] Open
Abstract
Age is a risk factor for both cardiovascular disease and cancer, and as such radiation oncologists frequently see a number of patients with cardiac implantable electronic devices (CIEDs) receiving proton therapy (PT). CIED malfunctions induced by PT are nonnegligible and can occur in both passive scattering and pencil beam scanning modes. In the absence of an evidence-based protocol, the authors emphasise that this patient cohort should be managed differently to electron- and photon- external beam radiation therapy (EBRT) patients due to distinct properties of proton beams. Given the lack of a PT-specific guideline for managing this cohort and limited studies on this important topic; the process was initiated by evaluating all PT-related CIED malfunctions to provide a baseline for future reporting and research. In this review, different modes of PT and their interactions with a variety of CIEDs and pacing leads are discussed. Effects of PT on CIEDs were classified into a variety of hardware and software malfunctions. Apart from secondary neutrons, cumulative radiation dose, dose rate, CIED model/manufacturer, distance from CIED to proton field, and materials used in CIEDs/pacing leads were all evaluated to determine the probability of malfunctions. The importance of proton beam arrangements is highlighted in this study. Manufacturers should specify recommended dose limits for patients undergoing PT. The establishment of an international multidisciplinary team dedicated to CIED-bearing patients receiving PT may be beneficial.
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Affiliation(s)
- Milad Mirzaei
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- Department of Medical Imaging and Radiation Sciences, School of Biomedical Sciences, Monash University, Clayton, VIC, Australia
| | - Pejman Rowshanfarzad
- School of Physics, Mathematics and Computing, The University of Western Australia, Crawley, WA, Australia
| | - Suki Gill
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- School of Physics, Mathematics and Computing, The University of Western Australia, Crawley, WA, Australia
| | - Martin A. Ebert
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- School of Physics, Mathematics and Computing, The University of Western Australia, Crawley, WA, Australia
| | - Joshua Dass
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
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Matsubara H. Neutron dose from a 6-MV X-ray beam in radiotherapy. Radiol Phys Technol 2023; 16:186-194. [PMID: 36780121 DOI: 10.1007/s12194-023-00705-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/14/2023]
Abstract
Although a 6-MV X-ray beam is employed clinically as a non-neutron-producing beam, no studies have reported how few neutrons are produced from a 6-MV beam. This study aimed to theoretically deduce the neutron dose from a 6-MV beam using Monte Carlo simulations for the notification of safety and risk in radiotherapy. Nuclei from a nuclear database with neutron separation energies below 6 MeV were surveyed, suggesting that the certain content of 2H in the human body may result in some contribution. Thus, Monte Carlo calculation considering 2H in a phantom was performed. The calculation suggested that the distribution of the neutron dose from a 6-MV beam consisted of two components: one had neutrons from 2H concentrated within an irradiation field, and the other had those due to other elements such as 183W spreading from a gantry head to a treatment room. Although uncertainty owing to the normalization factor of the Monte Carlo calculations was a factor of three, the neutron doses at distances of 0 and 50 cm from an irradiation field were calculated as 27 and 1.5 nSv/MU, respectively, under intensity-modulated radiotherapy (IMRT) or volumetric modulated arc therapy (VMAT). The calculations suggest that neutrons produced by a 6-MV beam are approximately 70 and 20 times safer than those by a 10-MV beam in the case of IMRT/VMAT and total body irradiation, respectively. Thus, this study theoretically reported the approximate number of neutrons delivered by a 6-MV beam for the first time.
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Affiliation(s)
- Hiroaki Matsubara
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan. .,Faculty of Radiological Technology, Fujita Health University, Aichi, 470-1192, Japan.
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Hashimoto T, Demizu Y, Numajiri H, Isobe T, Fukuda S, Wakatsuki M, Yamashita H, Murayama S, Takamatsu S, Katoh H, Murata K, Kohno R, Arimura T, Matsuura T, Ito YM. Particle therapy using protons or carbon ions for cancer patients with cardiac implantable electronic devices (CIED): a retrospective multi-institutional study. Jpn J Radiol 2021; 40:525-533. [PMID: 34779984 PMCID: PMC9068656 DOI: 10.1007/s11604-021-01218-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/05/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the outcomes of particle therapy in cancer patients with cardiac implantable electronic devices (CIEDs). MATERIALS AND METHODS From April 2001 to March 2013, 19,585 patients were treated with proton beam therapy (PBT) or carbon ion therapy (CIT) at 8 institutions. Of these, 69 patients (0.4%, PBT 46, CIT 22, and PBT + CIT 1) with CIEDs (64 pacemakers, 4 implantable cardioverter defibrillators, and 1 with a cardiac resynchronization therapy defibrillator) were retrospectively reviewed. All the patients with CIEDs in this study were treated with the passive scattering type of particle beam therapy. RESULTS Six (13%) of the 47 PBT patients, and none of the 23 CIT patients experienced CIED malfunctions (p = 0.105). Electrical resets (7) and over-sensing (3) occurred transiently in 6 patients. The distance between the edge of the irradiation field and the CIED was not associated with the incidence of malfunctions in 20 patients with lung cancer. A larger field size had a higher event rate but the test to evaluate trends as not statistically significant (p = 0.196). CONCLUSION Differences in the frequency of occurrence of device malfunctions for patients treated with PBT and patients treated with CIT did not reach statistical significance. The present study can be regarded as a benchmark study about the incidence of malfunctioning of CIED in passive scattering particle beam therapy and can be used as a reference for active scanning particle beam therapy.
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Affiliation(s)
- Takayuki Hashimoto
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, North 15 West 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Yusuke Demizu
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Kouto, Shingu-cho, Tatsuno, Hyogo, Japan
| | - Haruko Numajiri
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Tomonori Isobe
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Shigekazu Fukuda
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, Japan
| | - Masaru Wakatsuki
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, Japan
| | - Haruo Yamashita
- Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Shigeyuki Murayama
- Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Shigeyuki Takamatsu
- Department of Radiation Therapy, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, Japan
| | - Hiroyuki Katoh
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, Japan
- Department of Radiation Oncology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa, Japan
| | - Kazutoshi Murata
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, Japan
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, Japan
| | - Ryosuke Kohno
- National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, Japan
- Department of Accelerator and Medical Physics, National Institute for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, Japan
| | - Takeshi Arimura
- Medipolis Proton Therapy and Research Center, 4423, Higashikata, Ibusuki, Kagoshima, Japan
| | - Taeko Matsuura
- Faculty of Engineering, Hokkaido University, Kita 13, Nishi 8, Kita-ku, Sapporo, Hokkaido, Japan
| | - Yoichi M Ito
- Biostatistics Division, Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, Japan
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Fradley MG, Lefebvre B, Carver J, Cheung JW, Feigenberg SJ, Lampert R, Liu J, Rajagopalan B, Lenihan DJ. How to Manage Patients With Cardiac Implantable Electronic Devices Undergoing Radiation Therapy. JACC: CARDIOONCOLOGY 2021; 3:447-451. [PMID: 34604807 PMCID: PMC8463726 DOI: 10.1016/j.jaccao.2021.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Michael G Fradley
- Cardio-Oncology Translational Center of Excellence, Division of Cardiology and Abramson Cancer Center, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bénédicte Lefebvre
- Cardio-Oncology Translational Center of Excellence, Division of Cardiology and Abramson Cancer Center, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joseph Carver
- Cardio-Oncology Translational Center of Excellence, Division of Cardiology and Abramson Cancer Center, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jim W Cheung
- Weill Cornell Medicine, Department of Medicine, New York, New York, USA
| | - Steven J Feigenberg
- Department of Radiation Oncology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachel Lampert
- Department of Medicine (Cardiovascular Disease/Electrophysiology), Yale School of Medicine, New Haven, Connecticut, USA
| | - Jennifer Liu
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | | | - Daniel J Lenihan
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri, USA
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Matsubara H, Ezura T, Hashimoto Y, Karasawa K, Nishio T, Tsuneda M. Study of feasible and safe condition for total body irradiation using cardiac implantable electronic devices. JOURNAL OF RADIATION RESEARCH 2021:rrab088. [PMID: 34542633 DOI: 10.1093/jrr/rrab088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/09/2021] [Indexed: 06/13/2023]
Abstract
Cardiac implantable electronic devices (CIEDs) were believed to have a tolerance dose and that direct irradiation has to be avoided. Thus, no clinical guidelines have mentioned the feasibility of total body irradiation (TBI) with a CIED directly. The purpose of this work was to study a feasible and safe condition for TBI using a CIED. Eighteen CIEDs were directly irradiated by a 6-MV X-ray beam, where a non-neutron producible beam was employed for the removal of any neutron contribution to CIED malfunction. Irradiation up to 10 Gy in accumulated dose was conducted with a 100-cGy/min dose rate, followed by up to 20 Gy at 200 cGy/min. An irradiation test of whether inappropriate ventricular shock therapy was triggered or not was also performed by using a 6-MV beam of 5, 10, 20 and 40 cGy/min to two CIEDs. No malfunction was observed during irradiation up to 20 Gy at 100 and 200 cGy/min without activation of shock therapy. These results were compared with typical TBI, suggesting that a CIED in TBI will not encounter malfunction because the prescribed dose and the dose rate required for TBI are much safer than those used in this experiment. Several inappropriate shock therapies were, however, observed even at 10 cGy/min if activated. The present result suggested that TBI was feasible and safe if a non-neutron producible beam was employed at low dose-rate without activation of shock therapy, where it was not inconsistent with clinical and non-clinical data in the literature. The feasibility of TBI while using a CIED was discussed for the first time.
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Affiliation(s)
- Hiroaki Matsubara
- Department of Radiation Oncology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Takatomo Ezura
- Department of Radiology, Tokyo Women's Medical University Hospital, Tokyo 162-8666, Japan
| | - Yaichiro Hashimoto
- Department of Radiation Oncology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Kumiko Karasawa
- Department of Radiation Oncology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Teiji Nishio
- Department of Radiation Oncology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Masato Tsuneda
- Department of Radiation Oncology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
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Azraai M, D'Souza D, Lin YH, Nadurata V. Current clinical practice in patients with cardiac implantable electronic devices undergoing radiotherapy: a literature review. Europace 2021; 24:362-374. [PMID: 34516616 DOI: 10.1093/europace/euab241] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/25/2021] [Indexed: 12/25/2022] Open
Abstract
Patients with cardiac implantable electronic devices (CIED) undergoing radiotherapy (RT) are more common due to the ageing of the population. With newer CIEDs' implementing the complementary metal-oxide semiconductor (CMOS) technology which allows the miniaturization of CIED, it is also more susceptible to RT. Effects of RT on CIED ranges from device interference, device operational/memory errors of permanent damage. These malfunctions can cause life-threatening clinical effects. Cumulative dose is not the only component of RT that causes CIED malfunction, as neutron use and dose rate effect also affects CIEDs. The management of this patient cohort in clinical practice is inconsistent due to the lack of a consistent guideline from manufacturers and physician specialty societies. Our review will focus on the current clinical practice and the recently updated guidelines of managing patients with CIED undergoing RT. We aim to simplify the evidence and provide a simple and easy to use guide based on the recent guidelines.
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Affiliation(s)
- Meor Azraai
- Department of Cardiology, Bendigo Health, 100 Barnard Street, Bendigo, Victoria 3550, Australia
| | - Daniel D'Souza
- Department of Cardiology, Bendigo Health, 100 Barnard Street, Bendigo, Victoria 3550, Australia
| | - Yuan-Hong Lin
- Department of Cardiology, Bendigo Health, 100 Barnard Street, Bendigo, Victoria 3550, Australia
| | - Voltaire Nadurata
- Department of Cardiology, Bendigo Health, 100 Barnard Street, Bendigo, Victoria 3550, Australia
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Nakamura K, Aoyama T, Kaneda N, Otsuji M, Minami Y, Sakuragi A, Nakamura M. Implantable cardiac pacemaker failure by cumulative dose effects of flattening filter free beams. JOURNAL OF RADIATION RESEARCH 2021; 62:735-739. [PMID: 34036327 PMCID: PMC8273809 DOI: 10.1093/jrr/rrab041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/30/2021] [Indexed: 06/12/2023]
Abstract
Cumulative dose effects, which are one of the main causes of errors that occur when an implantable cardiac pacemaker (ICP) is irradiated with ionizing radiation, induce permanent failure in ICPs. Although flattening filter free (FFF) beams, which are often used in stereotactic radiotherapy, are known to have different characteristics from conventional (with flattening filter [WFF]) beams, the cumulative dose effects on ICPs with FFF beams have been under-investigated. This study investigates ICP failure induced by cumulative dose effects of FFF beams. When the ICP placed in the center of the irradiation field was irradiated with 10 MV-FFF at 24 Gy/min, the cumulative dose at which failure occurred was evaluated on the basis of the failure criteria associated with high cumulative dose as described in the American Association of Physicists in Medicine Task Group 203. The ICP failures such as a mild battery depletion at a cumulative dose of 10 Gy, pacing-output voltage change >25% at a cumulative dose of 122 Gy, and the loss of telemetry capability at cumulative dose 134 Gy were induced by cumulative dose effects. The cumulative doses by which the cumulative dose effects of FFF beams induced ICP failure were not very different from those reported in previous studies with WFF beams. Therefore, radiotherapy with FFF beams (and WFF beams) for patients with ICP requires appropriate management for minimizing the cumulative dose effects.
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Affiliation(s)
- Kazuhiko Nakamura
- Corresponding author. Kazuhiko Nakamura, Department of Radiology, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195 Japan. E-mail: ; Fax: +81-561-78-6228
| | - Takahiro Aoyama
- Department of Radiation Oncology, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-Ku, Nagoya, Aichi 464-8681 Japan
- Graduate School of Medicine, Aichi Medical University, 1-1 Yazako-karimata, Nagakute, Aichi 480-1195 Japan
| | - Naoki Kaneda
- Department of Radiology, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195 Japan
| | - Masashi Otsuji
- Department of Clinical Engineering, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195 Japan
| | - Yoshitaka Minami
- Department of Radiology, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195 Japan
| | - Ami Sakuragi
- Department of Radiology, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195 Japan
| | - Masaru Nakamura
- Department of Radiology, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195 Japan
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