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Ideishi A, Yamagata K, Nishii T, Miyanooi H, Miyazaki Y, Wakamiya A, Shimamoto K, Ueda N, Nakajima K, Wada M, Kamakura T, Ishibashi K, Inoue Y, Miyamoto K, Noda T, Nagase S, Aiba T, Kusano K. Interference of cardiac implantable electronic devices and computed tomography imaging in the current era with a phantom model. J Arrhythm 2023; 39:580-585. [PMID: 37560271 PMCID: PMC10407191 DOI: 10.1002/joa3.12853] [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] [Received: 12/27/2022] [Revised: 03/20/2023] [Accepted: 04/02/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Cardiac implantable electronic devices are used in patients with cardiac rhythm disorders. Computed tomography irradiation is not prohibited for patients with cardiac implantable electronic devices, despite adverse events being reported. Hence, appropriate preparation and knowledge are required before computed tomography irradiation can be carried out in these patients. Since there is limited knowledge or literature about the influence of computed tomography irradiation in cases with recent cardiac implantable electronic devices, we aimed to evaluate the adverse events and elucidate the necessary and sufficient safety measures associated with this therapy. METHODS AND RESULTS We placed cardiac implantable electronic devices on an anthropomorphic phantom model and observed their electrical activity in electrograms, while various protocols of computed tomography irradiation were implemented and adverse events evaluated. Oversensing with pauses of up to 3.2 s was observed in standard computed tomography protocols, but ventricular tachyarrhythmia or other clinically significant events could not be confirmed. Oversensing with pauses of up to 8.0 s was observed and ventricular tachyarrhythmia was detected in the maximum-dose protocols. However, treatments such as antitachycardia pacing or shock therapy for ventricular tachyarrhythmia were not observed because of their absence. CONCLUSION Computed tomography irradiation for patients using cardiac implantable electronic devices is highly unlikely to cause clinically significant adverse events with the device settings and computed tomography protocols currently being used. Changing or monitoring the device settings routinely before computed tomography irradiation is not necessarily required for most patients.
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Affiliation(s)
- Akihito Ideishi
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
- Department of CardiologyFukuoka University School of MedicineFukuokaJapan
| | - Kenichiro Yamagata
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Tatsuya Nishii
- Department of RadiologyNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Hideto Miyanooi
- Department of RadiologyNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Yuichiro Miyazaki
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Akinori Wakamiya
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Keiko Shimamoto
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Nobuhiko Ueda
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Kenzaburo Nakajima
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Mitsuru Wada
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Tsukasa Kamakura
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Kohei Ishibashi
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Yuko Inoue
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Koji Miyamoto
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Takashi Noda
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Satoshi Nagase
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
- Department of Advanced Arrhythmia and Translational Medical ScienceNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Takeshi Aiba
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Kengo Kusano
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
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Dong F, Johnson P, Fong G, Nguyen A, Lauand F, Vienneau T. Impact of X-Ray Exposure From Computed Tomography on Wearable Insulin Delivery Devices. J Diabetes Sci Technol 2023:19322968231169722. [PMID: 37098714 DOI: 10.1177/19322968231169722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
BACKGROUND To investigate the impact of radiation exposure from a computed tomography (CT) scanner on the functional integrity of a wearable insulin delivery system. METHODS A total of 160 Omnipods and four personal diabetes managers (PDMs) were evenly divided into four groups: (1) control group (no radiation exposure), (2) typical radiation exposure group, (3) 4× typical radiation exposure group, and (4) scatter radiation group. Pods were attached to an anthropomorphic torso phantom on the abdomen (direct irradiation) or shoulder (scatter radiation) region. A third-generation dual-source CT scanner was used to scan the pods using either a typical exposure (used for routine CT abdominal study of a median size patient) or 4× typical exposure. A manufacturer-recommended 20-step functionality test was performed for all 160 Omnipods. RESULTS The radiation dose (measured in volume CT Dose index) was 16 mGy for a typical exposure, and 64 mGy for 4× typical exposure. The scatter radiation is less than 0.1 mGy. All Pods passed the functionality test except one pod in the scatter radiation group, which sounded an alarm due to occlusion. The blockage to the fluid was due to a kink in the soft cannula, a mechanical issue not caused by the radiation exposure. CONCLUSIONS This study suggests X-ray exposure levels used in radiological imaging procedures do not negatively impact the functional integrity of Omnipods. This finding may support the potential for the manufacturer to remove the warning that patients should remove the Pod for X-ray imaging procedures, which will have a huge impact on patient care.
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Affiliation(s)
- Frank Dong
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paul Johnson
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Grant Fong
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
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Watson RE, Yu L. Safety Considerations in MRI and CT. Continuum (Minneap Minn) 2023; 29:27-53. [PMID: 36795872 DOI: 10.1212/con.0000000000001213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE MRI and CT are indispensable imaging modalities for the evaluation of patients with neurologic disease, and each is particularly well suited to address specific clinical questions. Although both of these imaging modalities have excellent safety profiles in clinical use as a result of concerted and dedicated efforts, each has potential physical and procedural risks that the practitioner should be aware of, which are described in this article. LATEST DEVELOPMENTS Recent advancements have been made in understanding and reducing safety risks with MR and CT. The magnetic fields in MRI create risks for dangerous projectile accidents, radiofrequency burns, and deleterious interactions with implanted devices, and serious patient injuries and deaths have occurred. Ionizing radiation in CT may be associated with shorter-term deterministic effects on biological tissues at extremely high doses and longer-term stochastic effects related to mutagenesis and carcinogenesis at low doses. The cancer risk of radiation exposure in diagnostic CT is considered extremely low, and the benefit of an appropriately indicated CT examination far outweighs the potential risk. Continuing major efforts are centered on improving image quality and the diagnostic power of CT while concurrently keeping radiation doses as low as reasonably achievable. ESSENTIAL POINTS An understanding of these MRI and CT safety issues that are central to contemporary radiology practice is essential for the safe and effective treatment of patients with neurologic disease.
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Azraai M, Miura D, Lin YH, Rodrigues TS, Nadurata V. Incidence and Predictors of Cardiac Implantable Electronic Devices Malfunction with Radiotherapy Treatment. J Clin Med 2022; 11:jcm11216329. [PMID: 36362559 PMCID: PMC9654752 DOI: 10.3390/jcm11216329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 12/01/2022] Open
Abstract
Aims: To investigate the incidence of cardiac implantable electronic devices (CIED) malfunction with radiotherapy (RT) treatment and assess predictors of CIED malfunction. Methods: A 6-year retrospective analysis of patients who underwent RT with CIED identified through the radiation oncology electronic database. Clinical, RT (cumulative dose, dose per fraction, beam energy, beam energy dose, and anatomical area of RT) and CIED details (type, manufacturer, and device malfunction) were collected from electronic medical records. Results: We identified 441 patients with CIED who underwent RT. CIED encountered a permanent pacemaker (PPM) (78%), cardiac resynchronization therapy—pacing (CRT-P) (2%), an implantable cardioverter defibrillator (ICD) (10%), and a CRT-defibrillator (CRT-D) (10%). The mean cumulative dose of RT was 36 gray (Gy) (IQR 1.8–80 Gy) and the most common beam energy used was photon ≥10 megavolt (MV) with a median dose of 7 MV (IQR 5–18 MV). We further identified 17 patients who had CIED malfunction with RT. This group had a higher cumulative RT dose of 42.5 Gy (20–77 Gy) and a photon dose of 14 MV (12–18 MV). None of the malfunctions resulted in clinical symptoms. Using logistic regression, the predictors of CIED malfunction were photon beam energy use ≥10 MV (OR 5.73; 95% CI, 1.58–10.76), anatomical location of RT above the diaphragm (OR 5.2, 95% CI, 1.82–15.2), and having a CIED from the ICD group (OR 4.6, 95% CI, 0.75–10.2). Conclusion: Clinicians should be aware of predictors of CIED malfunction with RT to ensure the safety of patients.
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Affiliation(s)
- Meor Azraai
- Department of Cardiology, Bendigo Health, Bendigo, VIC 3550, Australia
- Faculty of Medicine, Nursing and Health Sciences, School of Rural Health, Monash University, Melbourne, VIC 3550, Australia
- Correspondence: or ; Tel.: +613-5454-6000
| | - Daisuke Miura
- Department of Cardiology, Bendigo Health, Bendigo, VIC 3550, Australia
| | - Yuan-Hong Lin
- Department of Radiation Oncology, Peter McCallum, Bendigo Health, Bendigo, VIC 3550, Australia
| | - Thalys Sampaio Rodrigues
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Voltaire Nadurata
- Department of Cardiology, Bendigo Health, Bendigo, VIC 3550, Australia
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Tsutsui K, Kato R, Mori H, Kawano D, Ikeda Y, Matsumoto K, Tanaka N, Hoya H, Seki K, Yokoyama S, Yoshida Y, Iida S, Yamamoto K, Nakano S, Iwanaga S, Muramatsu T, Matsumoto K. Chest Computer Tomography is Safe Without Additional Interrogation or Monitoring for Modern Cardiac Implantable Electrical Devices. J Cardiovasc Electrophysiol 2022; 33:1336-1340. [DOI: 10.1111/jce.15475] [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: 10/11/2021] [Revised: 02/24/2022] [Accepted: 02/27/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Kenta Tsutsui
- Department of Cardiovascular MedicineSaitama Medical University International Medical CenterSaitamaJapan
| | - Ritsushi Kato
- Department of Cardiovascular MedicineSaitama Medical University International Medical CenterSaitamaJapan
| | - Hitoshi Mori
- Department of Cardiovascular MedicineSaitama Medical University International Medical CenterSaitamaJapan
| | - Daisuke Kawano
- Department of Cardiovascular MedicineSaitama Medical University International Medical CenterSaitamaJapan
| | - Yoshifumi Ikeda
- Department of Cardiovascular MedicineSaitama Medical University International Medical CenterSaitamaJapan
| | - Kei Matsumoto
- Department of Cardiovascular MedicineSaitama Medical University International Medical CenterSaitamaJapan
| | - Naomichi Tanaka
- Department of Cardiovascular MedicineSaitama Medical University International Medical CenterSaitamaJapan
| | - Hiroki Hoya
- Department of Cardiovascular MedicineSaitama Medical University International Medical CenterSaitamaJapan
| | - Kaname Seki
- Department of Cardiovascular MedicineSaitama Medical University International Medical CenterSaitamaJapan
| | - Shinji Yokoyama
- Department of Medical EngineerSaitama Medical University International Medical CenterSaitama
| | - Yuzuru Yoshida
- Department of Medical EngineerSaitama Medical University International Medical CenterSaitama
| | - Shinichiro Iida
- Department of Cardiovascular MedicineSaitama Medical University HospitalSaitamaJapan
| | - Keiji Yamamoto
- Department of Cardiovascular MedicineSaitama Medical University HospitalSaitamaJapan
| | - Shintaro Nakano
- Department of Cardiovascular MedicineSaitama Medical University International Medical CenterSaitamaJapan
| | - Siro Iwanaga
- Department of Cardiovascular MedicineSaitama Medical University International Medical CenterSaitamaJapan
| | - Toshihiro Muramatsu
- Department of Cardiovascular MedicineSaitama Medical University International Medical CenterSaitamaJapan
| | - Kazuo Matsumoto
- Department of Cardiovascular MedicineSaitama Medical University International Medical CenterSaitamaJapan
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Chyou JY, Sanz J. Chest Computed Tomography Imaging and Cardiac Implantable Electronic Devices. J Cardiovasc Electrophysiol 2022; 33:1341-1343. [DOI: 10.1111/jce.15476] [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: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Janice Y Chyou
- Icahn School of Medicine at Mount Sinai, Medicine, CardiologyNew YorkNYUSA
| | - Javier Sanz
- Icahn School of Medicine at Mount Sinai, Medicine, CardiologyNew YorkNYUSA
- Icahn School of Medicine at Mount Sinai, Diagnostic, Molecular and Interventional RadiologyNew YorkNYUSA
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Azraai M, D'Souza D, Nadurata V. Current Clinical Practice in Patients With Cardiac Implantable Electronic Devices (CIED) Undergoing Radiotherapy (RT). Heart Lung Circ 2021; 31:327-340. [PMID: 34844904 DOI: 10.1016/j.hlc.2021.10.020] [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: 05/28/2021] [Revised: 10/05/2021] [Accepted: 10/25/2021] [Indexed: 11/26/2022]
Abstract
Patients with cardiac implantable electronic devices (CIED) undergoing radiotherapy (RT) are more common due to ageing of the population. With newer CIEDs implementing the complementary metal-oxide semiconductor (CMOS) technology which allows the miniaturisation 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 lack of a consistent guideline from manufacturers and physician specialty societies. Our review will focus on the current clinical practice and the recent 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, Bendigo, Vic, Australia.
| | - Daniel D'Souza
- Department of Cardiology, Bendigo Health, Bendigo, Vic, Australia
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8
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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: 2] [Impact Index Per Article: 0.7] [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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9
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Long Z, Kurup AN, Jensen NM, Hangiandreou NJ, Schueler BA, Yu L, Leng S, Wood CP, Felmlee JP. Initial testing of pegfilgrastim (Neulasta Onpro) on-body injector in multiple radiological imaging environments. J Appl Clin Med Phys 2021; 22:343-349. [PMID: 33395503 PMCID: PMC7856482 DOI: 10.1002/acm2.13156] [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] [Received: 06/03/2020] [Revised: 12/07/2020] [Accepted: 12/12/2020] [Indexed: 11/15/2022] Open
Abstract
Purpose An increasing number of implantable or external devices can impact whether patients can receive radiological imaging examinations. This study examines and tests the Neulasta (pegfilgrastim) Onpro on‐body injector in multiple imaging environments. Methods The injector was analyzed for four imaging modalities with testing protocols and strategies developed for each modality. In x‐ray and computed tomography (CT), scans with much higher exposure than clinical protocols were performed with the device attached to an anthropomorphic phantom. The device was monitored until the completion of drug delivery. For magnetic resonance imaging (MRI), the device was assessed using a hand‐held magnet and underwent the magnetically induced displacement testing in a 1.5T clinical MRI scanner room. For ultrasound, magnetic field changes were measured around an ultrasound scanner system with three transducers. Results For x‐ray and CT no sign of device error was identified during or after the high radiation exposure scans. Drug delivery was completed at expected timing with expected volume. For MRI the device showed significant attractive force towards the hand‐held magnet and a 50‐degree deflection angle at 50 cm from the opening of the scanner bore. No further assessment from the gradient or radiofrequency field was deemed necessary. For ultrasound the maximum magnetic field change from baseline was measured to be +11.7 μT in comparison to +74.2 μT at 4 inches from a working microwave. Conclusions No device performance issue was identified under the extreme test conditions in x‐ray or CT. The device was found to be MR Unsafe. Magnetic field changes around an ultrasound system met the limitation set by manufacture. Patient ultrasound scanning is considered safe as long as the transducers do not inadvertently loosen the device.
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Affiliation(s)
- Zaiyang Long
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Lifeng Yu
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Shuai Leng
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Joel P Felmlee
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Gimenez De Lorenzo R, Navarra R, Marinelli D, Adorante N, Giancaterino S, Di Carlo C, Di Biase S, Rosa C, Falco MD. Effects of high-energy photon beam radiation therapy on Jarvik 2000 LVAD: in vitro evaluation. Radiol Med 2020; 125:561-568. [PMID: 32067164 DOI: 10.1007/s11547-020-01154-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/06/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Left ventricular assist device (LVAD) is considered a standard care for patients with advanced heart failure. The aim of this work was to study in vitro the effects of direct exposure of the Jarvik 2000 LVAD to 10-MV photon beams. METHODS Jarvik 2000 pump was immersed in a siliconized box filled with deionized water. A 30 × 30 × 15 cm RW3 slabs were added forth and back to the box. A treatment plan consisting of a single direct 10 × 10 cm2 field size beam was used to deliver 1000 MU at the center of the pump. During irradiation, the external Flow Maker controller and the lithium battery were positioned away from the beam. Pump parameter data (included voltage, current and frequency) were measured, recorded and analyzed for changes in pump function among baseline, pre-irradiation, during irradiation, post-irradiation and after 6 months. The whole session lasted 6 months. The Mann-Whitney U test was used to compare the repeated measurements. X-ray radiation attenuation was also studied. RESULTS The parameters investigated remained stable over the 6 months; that is, no pump stops, alarms, events, operational changes or abnormalities during the discharge rate of the connected power sources, were encountered, confirmed by the Mann-Whitney U test applied to all sessions (p > 0.1). The measured X-ray attenuation differed from the calculated one by TPS by 34%. CONCLUSION The Jarvik 2000 resulted stable under direct X-ray beam of 10-MV energy. Its strong attenuation, however, can affect dose deposition in the pump in TPS, and it must be taken into account.
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Affiliation(s)
- Ramon Gimenez De Lorenzo
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Riccardo Navarra
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy.,Department of Neuroimaging and Cognitive Science, University of Chieti "G. D'Annunzio", Chieti, Italy
| | - Daniele Marinelli
- Department of Cardiac Surgery, University of Chieti "G. D'Annunzio", Chieti, Italy
| | - Nico Adorante
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Stefano Giancaterino
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Clelia Di Carlo
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Saide Di Biase
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Consuelo Rosa
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Maria Daniela Falco
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy.
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Miften M, Mihailidis D, Kry SF, Reft C, Esquivel C, Farr J, Followill D, Hurkmans C, Liu A, Gayou O, Gossman M, Mahesh M, Popple R, Prisciandaro J, Wilkinson J. Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG-203 †. Med Phys 2019; 46:e757-e788. [PMID: 31571229 DOI: 10.1002/mp.13838] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/16/2019] [Accepted: 08/28/2019] [Indexed: 11/11/2022] Open
Abstract
Managing radiotherapy patients with implanted cardiac devices (implantable cardiac pacemakers and implantable cardioverter-defibrillators) has been a great practical and procedural challenge in radiation oncology practice. Since the publication of the AAPM TG-34 in 1994, large bodies of literature and case reports have been published about different kinds of radiation effects on modern technology implantable cardiac devices and patient management before, during, and after radiotherapy. This task group report provides the framework that analyzes the potential failure modes of these devices and lays out the methodology for patient management in a comprehensive and concise way, in every step of the entire radiotherapy process.
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Affiliation(s)
- Moyed Miften
- Task Group 203, Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Dimitris Mihailidis
- Task Group 203, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, PA, 19104, USA
| | - Stephen F Kry
- Department of Radiation Physics, UT MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Chester Reft
- Department of Radiation Oncology, University of Chicago, Chicago, IL, 60637, USA
| | - Carlos Esquivel
- Department of Radiation Oncology, UT Health Sciences Center, San Antonio, TX, 78229, USA
| | - Jonathan Farr
- Division of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - David Followill
- Department of Radiation Physics, UT MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Coen Hurkmans
- Department of Radiotherapy, Catharina Hospital, Eindhoven, the Netherlands
| | - Arthur Liu
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Olivier Gayou
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburg, PA, 15212, USA
| | - Michael Gossman
- Department of Radiation Oncology, Tri-State Regional Cancer Center, Ashland, KY, 41101, USA
| | - Mahadevappa Mahesh
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Richard Popple
- Department of Radiation Oncology, University of Alabama, Birmingham, AL, 35249, USA
| | - Joann Prisciandaro
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, 48109, USA
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12
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Pan EY, Luo D, Pan T. Potential effects of low-dose average CT on cardiac implantable electronic devices. J Nucl Cardiol 2019; 26:1161-1165. [PMID: 29344923 DOI: 10.1007/s12350-018-1186-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 12/29/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Average CT has been shown to be more accurate than conventional helical CT in quantitation of the PET data. The risk of CT irradiation of a cardiac implantable electronic device (CIED) causing an adverse event is low and is generally outweighed by the clinical benefit of a medically indicated examination. However, irradiation of CIED over one breath cycle in cine CT scan for average CT could impose risks on a patient who is pacing dependent. The purpose of this study was to demonstrate that low-dose average CT can be safe for CIED. METHODS A Medtronic CIED of model Protecta VR was submerged in a saline bath for a series of 4-s cine CT scans on a GE CT scanner programmed to deliver a 2-cm-wide radiation at a dose rate of 0.9 to 41.2 mGy/s to the CIED. The number of over-sensings was recorded as the interference of radiation to the CIED. RESULTS Dose rates ≥ 1.9 mGy/s caused over-sensing. The higher the dose rate, the more over-sensings there were. The lowest dose rate of 0.9 mGy/s did not cause any over-sensing. CONCLUSIONS Low-dose average CT at 0.9 mGy/s can be safe for a CIED patient who is pacing dependent.
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Affiliation(s)
- Emily Y Pan
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1352, Houston, TX, 70030-4009, USA
| | - Dershan Luo
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, 70030, USA
| | - Tinsu Pan
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1352, Houston, TX, 70030-4009, USA.
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Yamada T. Computed tomography continues to be the preferred tomographic imaging technology for patients with cardiac implantable electronic devices despite a potential risk of electrical interference by irradiation. J Nucl Cardiol 2019; 26:1166-1168. [PMID: 29511927 DOI: 10.1007/s12350-018-1246-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 02/19/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, FOT 930A, 510 20th Street South, Birmingham, AL, 35294-0019, USA.
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Urikura A, Hara T, Yoshida T, Nishimaru E, Hoshino T, Nakaya Y, Endo M. Overranging and overbeaming measurement in area detector computed tomography: A method for simultaneous measurement in volume helical acquisition. J Appl Clin Med Phys 2019; 20:160-165. [PMID: 31165567 PMCID: PMC6612690 DOI: 10.1002/acm2.12650] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/17/2019] [Accepted: 05/04/2019] [Indexed: 01/26/2023] Open
Abstract
Purpose We propose a novel method to assess overbeaming and overranging, as well as the effect of reducing longitudinal exposure range, by using a dynamic z‐collimator in area detector computed tomography. Methods and materials A 500‐mm diameter cylindrical imaging plate was exposed by helical scanning in a dark room. The beam collimation of the helical acquisitions was set at 32 and 80 mm. Overbeaming and overranging with the dynamic z‐collimator were measured. Results The actual beam widths were approximately 39 and 88 mm at 32 and 80 mm collimation, respectively, and were relatively reduced owing to increased beam collimation. Overranging was 27.0 and 48.2 mm with a pitch of 0.83 and 1.49 at 32 mm collimation and 72.5 and 83.1 mm with a pitch of 0.87 and 0.99 at 80 mm collimation. The dynamic z‐collimator relatively reduced the overranging by 17.3% and 17.1% for the 32 and 80 mm collimation, respectively. Conclusion We devised a method to simultaneously measure overbeaming and overranging with only one helical acquisition. Although the dynamic z‐collimator reduced the overranging by approximately 17%, wider collimation widths and higher pitch settings would increase the exposure dose outside the scan range.
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Affiliation(s)
- Atsushi Urikura
- Division of Diagnostic Radiology, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Takanori Hara
- Department of Medical Technology, Nakatsugawa Municipal General Hospital, Nakatsugawa, Japan
| | - Tsukasa Yoshida
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Eiji Nishimaru
- Department of Radiology, Hiroshima University Hospital, Hiroshima, Japan
| | - Takashi Hoshino
- Department of Radiological technology, Osaka College of High Technology, Osaka, Japan
| | - Yoshihiro Nakaya
- Division of Diagnostic Radiology, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Masahiro Endo
- Division of Diagnostic Radiology, Shizuoka Cancer Center, Nagaizumi, Japan
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CMR and CT of the Patient With Cardiac Devices. JACC Cardiovasc Imaging 2019; 12:890-903. [DOI: 10.1016/j.jcmg.2018.09.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/24/2018] [Accepted: 09/13/2018] [Indexed: 01/15/2023]
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Cao G, Chen W, Pan K, Sun H, Wang Z. Reduced artifacts and improved diagnostic value of 640-slice computed tomography in patients with cardiac pacemakers. J Int Med Res 2019; 47:1916-1926. [PMID: 30810074 PMCID: PMC6567773 DOI: 10.1177/0300060519825986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective The aim of this study was to compare the feasibility of 640-slice with 64-slice computed tomography (CT) coronary angiography for diagnosing coronary lesions in patients with pacemakers. Methods Forty-five and 50 patients with pacemakers and with suspected or known coronary artery disease underwent 64-slice (64 group) and 640-slice (640 group) CT scans, respectively. All segments of the vessels were evaluated according to the 15-segment model recommended by the American Heart Association. Results The incidence of moderate or severe artifacts was significantly lower (7.27% vs. 32.17%) and the diagnosable rate for coronary lesions was higher (98.91% vs. 94.19%) in the 640 compared with the 64 group. In the 64 group, the incidence of artifacts in patients with a heart rate >65 bpm (20.98%) was higher than in those with a heart rate <65 bpm (15.67%), although the difference was not significant, while the incidence of artifacts was significantly higher in patients with heart arrhythmia (21.40%) compared with in those with normal heart rhythm (15.09%). Conclusions Among patients with pacemakers and a higher heart rate or heart arrhythmia, 640-slice CT may be more effective than 64-slice CT for diagnosing coronary lesions, by reducing moderate and severe artifacts.
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Affiliation(s)
- Guoquan Cao
- 1 Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Weijian Chen
- 1 Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Kehua Pan
- 1 Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Houchang Sun
- 1 Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhen Wang
- 2 Department of Radiology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang Province, China
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Stawiarski K, Sorajja D, Ramakrishna H. Magnetic Resonance and Computed Tomography Imaging in Patients with Cardiovascular Implantable Electronic Devices: Analysis of Expert Consensus Data and Implications for the Perioperative Clinician. J Cardiothorac Vasc Anesth 2018; 32:2817-2822. [DOI: 10.1053/j.jvca.2018.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Indexed: 11/11/2022]
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Whicher CA, Humayun M, Jenkins E, Brooks M, Benbow M, Critoph C, Partridge H. Evaluating insulin pump functionality during ionising radiation exposure. PRACTICAL DIABETES 2017. [DOI: 10.1002/pdi.2142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Indik JH, Gimbel JR, Abe H, Alkmim-Teixeira R, Birgersdotter-Green U, Clarke GD, Dickfeld TML, Froelich JW, Grant J, Hayes DL, Heidbuchel H, Idriss SF, Kanal E, Lampert R, Machado CE, Mandrola JM, Nazarian S, Patton KK, Rozner MA, Russo RJ, Shen WK, Shinbane JS, Teo WS, Uribe W, Verma A, Wilkoff BL, Woodard PK. 2017 HRS expert consensus statement on magnetic resonance imaging and radiation exposure in patients with cardiovascular implantable electronic devices. Heart Rhythm 2017; 14:e97-e153. [DOI: 10.1016/j.hrthm.2017.04.025] [Citation(s) in RCA: 238] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Indexed: 11/16/2022]
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20
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Emerson LY, Deek MP, Almendral J, Jabbour SK. Radiation therapy in patients with left ventricular assist device: A case report and literature review. Pract Radiat Oncol 2016; 6:e145-e147. [PMID: 27017262 DOI: 10.1016/j.prro.2015.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/25/2015] [Accepted: 12/03/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Liane Y Emerson
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Matthew P Deek
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Jesus Almendral
- Rutgers Robert Wood Johnson Medical School, Division of Cardiovascular Disease and Hypertension, Rutgers University, New Brunswick, New Jersey
| | - Salma K Jabbour
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey.
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Ghaly RF, Tverdohleb T, Candido KD, Knezevic NN. Do we need to establish guidelines for patients with neuromodulation implantable devices, including spinal cord stimulators undergoing nonspinal surgeries? Surg Neurol Int 2016; 7:18. [PMID: 26958424 PMCID: PMC4766801 DOI: 10.4103/2152-7806.176373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 01/05/2016] [Indexed: 12/31/2022] Open
Abstract
Background: Spinal cord stimulation is currently approved to treat chronic intractable pain of the trunk and limbs. However, such implantable electronic devices are vulnerable to external electrical currents and magnetic fields. Within the hospitals and modern operating rooms (ORs), there is an abundance of electrical devices and other types of equipment that could interfere with such devices. Despite the increasing number of patients with neuromodulation implantable devices, there are no written guidelines available or consensus of cautions for such patients undergoing unrelated surgery. Case Descriptions: A 60-year-old female with a permanent St. Jude's spinal cord stimulator (SCS) presented for open total abdominal hysterectomy. Both the anesthesia and gynecology staffs were aware of the device presence, but were unaware of any precautions regarding intraoperative management. The device was found to be nonmagnetic resonance imaging compatible, and bipolar cautery was used instead of monopolar cautery. A 59-year-old female with a 9-year-old permanent Medtronic SCS, presented for right total hip arthroplasty. The device was switched off prior to entering the OR, bipolar cautery was used, and grounding pads were placed away from her battery site. In each case, the manufacturer's representative was contacted preoperative. Both surgeries proceeded uneventfully. Conclusions: The Food and Drug Administration safety information manual warns about the use of diathermy, concomitant implanted stimulation devices, lithotripsy, external defibrillation, radiation therapy, ultrasonic scanning, and high-output ultrasound, all of which can lead to permanent implant damage if not turned off prior to undertaking procedures. Lack of uniform guidelines makes intraoperative management, as well as remote anesthesia care of patients with previously implanted SCSs unsafe.
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Affiliation(s)
- Ramsis F Ghaly
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA; Department of Anesthesiology, JHS Hospital of Cook County, Chicago, IL, USA; Ghaly Neurosurgical Associates, Aurora, IL, USA; Department of Anesthesiology, University of Illinois, Chicago, IL, USA
| | - Tatiana Tverdohleb
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - Kenneth D Candido
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA; Department of Anesthesiology, University of Illinois, Chicago, IL, USA
| | - Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA; Department of Anesthesiology, University of Illinois, Chicago, IL, USA
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Walsh KM, Machado AG, Krishnaney AA. Spinal cord stimulation: a review of the safety literature and proposal for perioperative evaluation and management. Spine J 2015; 15:1864-9. [PMID: 25957536 DOI: 10.1016/j.spinee.2015.04.043] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/03/2015] [Accepted: 04/29/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT There is currently no consensus on appropriate perioperative management of patients with spinal cord stimulator implants. Magnetic resonance imaging (MRI) is considered safe under strict labeling conditions. Electrocautery is generally not recommended in these patients but sometimes used despite known risks. PURPOSE The aim was to discuss the perioperative evaluation and management of patients with spinal cord stimulator implants. STUDY DESIGN A literature review, summary of device labeling, and editorial were performed, regarding the safety of spinal cord stimulator devices in the perioperative setting. METHODS A literature review was performed, and the labeling of each Food and Drug Administration (FDA)-approved spinal cord stimulation system was reviewed. The literature review was performed using PubMed and the FDA website (www.fda.gov). RESULTS Magnetic resonance imaging safety recommendations vary between the models. Certain systems allow for MRI of the brain to be performed, and only one system allows for MRI of the body to be performed, both under strict labeling conditions. Before an MRI is performed, it is imperative to ascertain that the system is intact, without any lead breaks or low impedances, as these can result in heating of the spinal cord stimulation (SCS) and injury to the patient. Monopolar electrocautery is generally not recommended for patients with SCS; however, in some circumstances, it is used when deemed required by the surgeon. When cautery is necessary, bipolar electrocautery is recommended. Modern electrocautery units are to be used with caution as there remains a risk of thermal injury to the tissue in contact with the SCS. As with MRI, electrocautery usage in patients with SCS systems with suspected breaks or abnormal impedances is unsafe and may cause injury to the patient. CONCLUSIONS Spinal cord stimulation is increasingly used in patients with pain of spinal origin, particularly to manage postlaminectomy syndrome. Knowledge of the safety concerns of SCS and appropriate perioperative evaluation and management of the SCS system can reduce risks and improve surgical planning.
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Affiliation(s)
- Kevin M Walsh
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., S40, Cleveland, OH 44195, USA.
| | - Andre G Machado
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., S40, Cleveland, OH 44195, USA; Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, 500 Euclid Ave., Cleveland, OH 44195, USA; Center for Spine Health, Neurological Institute, Cleveland Clinic, 500 Euclid Ave., Cleveland, OH 44195, USA
| | - Ajit A Krishnaney
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., S40, Cleveland, OH 44195, USA; Center for Spine Health, Neurological Institute, Cleveland Clinic, 500 Euclid Ave., Cleveland, OH 44195, USA
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Zaremba T, Jakobsen AR, Søgaard M, Thøgersen AM, Riahi S. Radiotherapy in patients with pacemakers and implantable cardioverter defibrillators: a literature review. Europace 2015; 18:479-91. [PMID: 26041870 DOI: 10.1093/europace/euv135] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 04/16/2015] [Indexed: 11/14/2022] Open
Abstract
An increasing number of patients with implantable cardiac rhythm devices undergo radiotherapy (RT) for cancer and are thereby exposed to the risk of device failure. Current safety recommendations seem to have limitations by not accounting for the risk of pacemakers and implantable cardioverter defibrillators malfunctioning at low radiation doses. Besides scant knowledge about optimal safety measures, only little is known about the exact prevalence of patients with devices undergoing RT. In this review, we provide a short overview of the principles of RT and present the current evidence on the predictors and mechanisms of device malfunctions during RT. We also summarize practical recommendations from recent publications and from the industry. Strongly associated with beam energy of photon RT, device malfunctions occur at ∼3% of RT courses, posing a substantial issue in clinical practice. Malfunctions described in the literature typically consist of transient software disturbances and only seldom manifest as a permanent damage of the device. Through close cooperation between cardiologists and oncologists, a tailored individualized approach might be necessary in this patient group in waiting time for updated international guidelines in the field.
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Affiliation(s)
- Tomas Zaremba
- Department of Cardiology, Center for Cardiovascular Research, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9000, Denmark
| | - Annette Ross Jakobsen
- Department of Medical Physics, Oncology Department, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9000, Denmark
| | - Mette Søgaard
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N 8200, Denmark
| | - Anna Margrethe Thøgersen
- Department of Cardiology, Center for Cardiovascular Research, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9000, Denmark
| | - Sam Riahi
- Department of Cardiology, Center for Cardiovascular Research, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9000, Denmark Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Sdr. Skovvej 15, Aalborg 9000, Denmark
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DEGRO/DGK guideline for radiotherapy in patients with cardiac implantable electronic devices. Strahlenther Onkol 2015; 191:393-404. [PMID: 25739476 DOI: 10.1007/s00066-015-0817-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 01/22/2015] [Indexed: 01/16/2023]
Abstract
An increasing number of patients undergoing radiotherapy (RT) have cardiac implantable electronic devices [CIEDs, cardiac pacemakers (PMs) and implanted cardioverters/defibrillators (ICDs)]. Ionizing radiation can cause latent and permanent damage to CIEDs, which may result in loss of function in patients with asystole or ventricular fibrillation. Reviewing the current literature, the interdisciplinary German guideline (DEGRO/DGK) was developed reflecting patient risk according to type of CIED, cardiac condition, and estimated radiation dose to the CIED. Planning for RT should consider the CIED specifications as well as patient-related characteristics (pacing-dependent, previous ventricular tachycardia/fibrillation). Antitachyarrhythmia therapy should be suspended in patients with ICDs, who should be under electrocardiographic monitoring with an external defibrillator on stand-by. The beam energy should be limited to 6 (to 10) MV CIEDs should never be located in the beam, and the cumulative scatter radiation dose should be limited to 2 Gy. Personnel must be able to respond adequately in the case of a cardiac emergency and initiate basic life support, while an emergency team capable of advanced life support should be available within 5 min. CIEDs need to be interrogated 1, 3, and 6 months after the last RT due to the risk of latent damage.
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Zaremba T, JAKOBSEN ANNETTEROSS, SØGAARD METTE, THØGERSEN ANNAMARGRETHE, JOHANSEN MARTINBERG, MADSEN LAERKEBRUUN, RIAHI SAM. Risk of Device Malfunction in Cancer Patients with Implantable Cardiac Device Undergoing Radiotherapy: A Population-Based Cohort Study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:343-56. [DOI: 10.1111/pace.12572] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 11/30/2014] [Accepted: 12/14/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Tomas Zaremba
- Department of Cardiology, Center for Cardiovascular Research; Aalborg University Hospital; Aalborg Denmark
| | - ANNETTE ROSS JAKOBSEN
- Department of Medical Physics, Oncology Department; Aalborg University Hospital; Aalborg Denmark
| | - METTE SØGAARD
- Department of Clinical Epidemiology, Institute of Clinical Medicine; Aarhus University Hospital; Aarhus Denmark
| | - ANNA MARGRETHE THØGERSEN
- Department of Cardiology, Center for Cardiovascular Research; Aalborg University Hospital; Aalborg Denmark
| | - MARTIN BERG JOHANSEN
- Department of Clinical Medicine; Aalborg University and Aalborg University Hospital; Aalborg Denmark
| | - LAERKE BRUUN MADSEN
- Department of Cardiology, Center for Cardiovascular Research; Aalborg University Hospital; Aalborg Denmark
| | - SAM RIAHI
- Department of Cardiology, Center for Cardiovascular Research; Aalborg University Hospital; Aalborg Denmark
- Department of Clinical Medicine; Aalborg University and Aalborg University Hospital; Aalborg Denmark
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Prisciandaro JI, Makkar A, Fox CJ, Hayman JA, Horwood L, Pelosi F, Moran JM. Dosimetric review of cardiac implantable electronic device patients receiving radiotherapy. J Appl Clin Med Phys 2015; 16:5189. [PMID: 25679176 PMCID: PMC5689988 DOI: 10.1120/jacmp.v16i1.5189] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 10/15/2014] [Accepted: 10/10/2014] [Indexed: 11/23/2022] Open
Abstract
A formal communication process was established and evaluated for the management of patients with cardiac implantable electronic devices (CIEDs) receiving radiation therapy (RT). Methods to estimate dose to the CIED were evaluated for their appropriateness in the management of these patients. A retrospective, institutional review board (IRB) approved study of 69 patients with CIEDs treated with RT between 2005 and 2011 was performed. The treatment sites, techniques, and the estimated doses to the CIEDs were analyzed and compared to estimates from published peripheral dose (PD) data and three treatment planning systems (TPSs) — UMPlan, Eclipse's AAA and Acuros algorithms. When measurements were indicated, radiation doses to the CIEDs ranged from 0.01–5.06 Gy. Total peripheral dose estimates based on publications differed from TLD measurements by an average of 0.94 Gy (0.05–4.49 Gy) and 0.51 Gy (0–2.74 Gy) for CIEDs within 2.5 cm and between 2.5 and 10 cm of the treatment field edge, respectively. Total peripheral dose estimates based on three TPSs differed from measurements by an average of 0.69 Gy (0.02–3.72 Gy) for CIEDs within 2.5 cm of the field edge. Of the 69 patients evaluated in this study, only two with defibrillators experienced a partial reset of their device during treatment. Based on this study, few CIED‐related events were observed during RT. The only noted correlation with treatment parameters for these two events was beam energy, as both patients were treated with high‐energy photon beams (16 MV). Differences in estimated and measured CIED doses were observed when using published PD data and TPS calculations. As such, we continue to follow conservative guidelines and measure CIED doses when the device is within 10 cm of the field or the estimated dose is greater than 2 Gy for pacemakers or 1 Gy for defibrillators. PACS number: 87.55.N‐
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Reply. J Am Coll Cardiol 2014; 64:2302-3. [DOI: 10.1016/j.jacc.2014.04.092] [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: 04/17/2014] [Accepted: 04/21/2014] [Indexed: 11/23/2022]
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28
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Effect of Computed Tomography Imaging on Rhythm Devices in Real-World Practice. J Am Coll Cardiol 2014; 64:2301-2. [DOI: 10.1016/j.jacc.2014.03.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 03/16/2014] [Indexed: 11/23/2022]
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29
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Cardiac Rhythm Management Devices. J Am Coll Cardiol 2014; 63:1776-7. [DOI: 10.1016/j.jacc.2014.01.043] [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: 01/14/2014] [Accepted: 01/23/2014] [Indexed: 11/19/2022]
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30
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Safety of Computed Tomography in Patients With Cardiac Rhythm Management Devices. J Am Coll Cardiol 2014; 63:1769-75. [DOI: 10.1016/j.jacc.2013.12.040] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 12/04/2013] [Accepted: 12/23/2013] [Indexed: 11/19/2022]
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31
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Tondato F, Ng DW, Srivathsan K, Altemose GT, Halyard MY, Scott LR. Radiotherapy-induced pacemaker and implantable cardioverter defibrillator malfunction. Expert Rev Med Devices 2014; 6:243-9. [DOI: 10.1586/erd.09.7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hurkmans CW, Knegjens JL, Oei BS, Maas AJJ, Uiterwaal GJ, van der Borden AJ, Ploegmakers MMJ, van Erven L. Management of radiation oncology patients with a pacemaker or ICD: a new comprehensive practical guideline in The Netherlands. Dutch Society of Radiotherapy and Oncology (NVRO). Radiat Oncol 2012; 7:198. [PMID: 23176563 PMCID: PMC3528416 DOI: 10.1186/1748-717x-7-198] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 11/21/2012] [Indexed: 11/13/2022] Open
Abstract
Current clinical guidelines for the management of radiotherapy patients having either a pacemaker or implantable cardioverter defibrillator (both CIEDs: Cardiac Implantable Electronic Devices) do not cover modern radiotherapy techniques and do not take the patient’s perspective into account. Available data on the frequency and cause of CIED failure during radiation therapy are limited and do not converge. The Dutch Society of Radiotherapy and Oncology (NVRO) initiated a multidisciplinary task group consisting of clinical physicists, cardiologists, radiation oncologists, pacemaker and ICD technologists to develop evidence based consensus guidelines for the management of CIED patients. CIED patients receiving radiotherapy should be categorised based on the chance of device failure and the clinical consequences in case of failure. Although there is no clear cut-off point nor a clear linear relationship, in general, chances of device failure increase with increasing doses. Clinical consequences of device failures like loss of pacing, carry the most risks in pacing dependent patients. Cumulative dose and pacing dependency have been combined to categorise patients into low, medium and high risk groups. Patients receiving a dose of less than 2 Gy to their CIED are categorised as low risk, unless pacing dependent since then they are medium risk. Between 2 and 10 Gy, all patients are categorised as medium risk, while above 10 Gy every patient is categorised as high risk. Measures to secure patient safety are described for each category. This guideline for the management of CIED patients receiving radiotherapy takes into account modern radiotherapy techniques, CIED technology, the patients’ perspective and the practical aspects necessary for the safe management of these patients. The guideline is implemented in The Netherlands in 2012 and is expected to find clinical acceptance outside The Netherlands as well.
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Affiliation(s)
- Coen W Hurkmans
- Catharina Hospital Eindhoven, Department of Radiation Oncology, Eindhoven, The Netherlands.
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Abstract
For patients with cardiac devices, cardiac computed tomography (CT) remains the mainstay for imaging due to its superior resolution as compared with echocardiography and nuclear studies and no contraindication to metal as with cardiac magnetic resonance imaging. This review focuses on the evaluation and pitfalls of coronary arterial imaging in patients with devices, such as pacemakers, implantable defibrillators, cardiac resynchronization therapy (CRT), as well as complications such as lead perforation and safety concerns of CT interference. We discuss both pre- and post-procedural CRT assessment for coronary venous imaging and pre-procedural myocardial scar assessment to localize regions of scar and peri-infarct zone to facilitate ventricular tachycardia ablation in patients with devices. We describe potential new research on dyssynchrony and integration with myocardial scar and site of latest activation for patients with or being considered for CRT. We detail the utility of CT for the assessment of proper function and complications in patients with left ventricular assist device implantation.
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Wootton LS, Polf JC, Peterson S, Wilkinson J, Rozner MA, Balter PA, Beddar S. Proton dose perturbations caused by high-voltage leads from implanted cardioverter defibrillators. J Appl Clin Med Phys 2012; 13:3813. [PMID: 22766952 PMCID: PMC3869963 DOI: 10.1120/jacmp.v13i4.3813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 03/21/2012] [Accepted: 03/13/2012] [Indexed: 11/23/2022] Open
Abstract
An increasing number of patients undergoing proton radiotherapy have cardiac implantable electrical devices (CIEDs). We recently encountered a situation in which a high‐voltage coil on a lead from an implanted cardiac defibrillator was located within the clinical treatment volume for a patient receiving proton radiotherapy for esophageal cancer. To study the effects of the lead on the dose delivery, we placed a high‐Z CIED lead at both the center and the distal edge of a clinical spread‐out Bragg peak (SOBP) in a water phantom, in both a stationary position and with the lead moving in a periodic pattern to simulate cardiorespiratory movement. We then calculated planned doses using a commercial proton treatment planning system (TPS), and compared them with the doses delivered in the phantom, measured using radiographic film. Dose profiles from TPS‐calculated and measured dose distributions showed large pertubrations in the delivered proton dose in the vicinity of the CIED lead when it was not moving. The TPS predicted perturbations up to 20% and measurements revealed perturbations up to 35%. However, the perturbations were less than 3% when the lead was moving. Greater dose perturbations were seen when the lead was placed at the distal edge of the SOBP than when it was placed in the center of the SOBP. We conclude that although cardiorespiratory motion of the lead mitigates some of the perturbations, the effects of the leads should be considered and steps taken to reduce these effects during the treatment planning process. PACS numbers: 87.55.D‐,87.55.ne, 87.85.M
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Affiliation(s)
- Landon S Wootton
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
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Misiri J, Kusumoto F, Goldschlager N. Electromagnetic interference and implanted cardiac devices: the medical environment (part II). Clin Cardiol 2012; 35:321-8. [PMID: 22539263 DOI: 10.1002/clc.21997] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 03/19/2012] [Accepted: 03/19/2012] [Indexed: 11/07/2022] Open
Abstract
Electromagnetic interference produced by medical equipment can interact with implanted cardiac devices such as pacemakers and implantable cardioverter-defibrillators. The most commonly observed interaction is in the operating room with electrosurgery. The risk of interactions can often be mitigated by close communication between the cardiac-device specialist and the anesthesiology/surgical team to develop a patient-specific strategy that accounts for factors such as type of device, type of surgery, and whether the patient is pacemaker dependent. Although magnetic resonance imaging should generally not be used in patients with implanted cardiac devices, several published guidelines provide strategies and recommendations for managing risks if magnetic resonance imaging is required with no suitable diagnostic alternatives. Other common sources of electromagnetic interference in the medical environment are ionizing radiation and left ventricular assist devices.
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Affiliation(s)
- Juna Misiri
- Department of Medicine, Division of Cardiovascular Disease, Electrophysiology and Pacing Service, Mayo Clinic, Jacksonville, Florida, USA
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Akiba N, Takeda M, Nakaya G, Nakamura O, Tsuboi M, Matsumoto J, Ito K, Okuyama Y, Shimada M, Yoshikawa K. Inhibition of the Oversensing of Cardiac Pacemakers in Chest CT. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ojmi.2012.24022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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The Heart Rhythm Society (HRS)/American Society of Anesthesiologists (ASA) Expert Consensus Statement on the perioperative management of patients with implantable defibrillators, pacemakers and arrhythmia monitors: facilities and patient management: executive summary this document was developed as a joint project with the American Society of Anesthesiologists (ASA), and in collaboration with the American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Heart Rhythm 2011; 8:e1-18. [PMID: 21722852 DOI: 10.1016/j.hrthm.2011.05.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Indexed: 12/13/2022]
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Beam Profile Disturbances from Implantable Pacemakers or Implantable Cardioverter-Defibrillator Interactions. Med Dosim 2011; 36:358-64. [DOI: 10.1016/j.meddos.2010.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 08/31/2010] [Accepted: 09/08/2010] [Indexed: 11/18/2022]
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COOLEN TIM, GHEKIERE OLIVIER, DJEKIC JULIEN, MANCINI ISABELLE, NCHIMI ALAIN. Tachycardia during Coronary Computed Tomography Angiography. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 35:360-2. [DOI: 10.1111/j.1540-8159.2011.03185.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ushijima T, Yamao Y, Nagasawa N, Matsuzuki M, Sasou T, Miyagi H, Maki H. [Partial electrical reset of CT irradiation on implantable cardiac devices: relationship between reset and tube voltage, tube current, and rotation time]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2011; 67:648-53. [PMID: 21720073 DOI: 10.6009/jjrt.67.648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim of this study was to investigate the relationship between partial electrical reset (PER) and CT scan parameters (tube voltage, tube current, rotation time, and product of tube current and rotation time in mAs). A cardiac resynchronization therapy pacemaker (Insync 8040, Medtronic Inc., Tokyo) and 320 area detector CT scanner (Aquilion ONE, Toshiba medical systems, Otawara, Japan) with volume scan were used. The pacemaker was put in DDD mode. The PERs were interpreted using both the programmer's wave forms and error messages. The exposure was repeated 5 times per CT setting. The pacemaker was placed on the anterior wall and upper side of a chest phantom. Each CT scan was performed using the following parameters: tube voltage of 80, 100, 120, and 135 kV; tube current of 50-550 mA; and rotation time of 0.35-1.5 s. PERs were observed at 100, 120, and 135 kV, and more PERs were observed as the tube voltage increased. The PER tube current decreased as the rotation time was increased. In contrast, the PER tube current and rotation time product (mAs) increased as the rotation time was increased. More specifically, the radiation dose rate was the affected factor of the PERs. To avoid PER of pacemakers, CT scan parameters with lower radiation dose rates (low rather than high tube current and rotational time) is recommended. In conclusion, our results will help with CT scans of patients who have implantable cardiac devices (included pacemakers and cardioverter defibrillators).
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Crossley GH, Poole JE, Rozner MA, Asirvatham SJ, Cheng A, Chung MK, Ferguson TB, Gallagher JD, Gold MR, Hoyt RH, Irefin S, Kusumoto FM, Moorman LP, Thompson A. The Heart Rhythm Society (HRS)/American Society of Anesthesiologists (ASA) Expert Consensus Statement on the Perioperative Management of Patients with Implantable Defibrillators, Pacemakers and Arrhythmia Monitors: Facilities and Patient Management. Heart Rhythm 2011; 8:1114-54. [DOI: 10.1016/j.hrthm.2010.12.023] [Citation(s) in RCA: 253] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Indexed: 11/26/2022]
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Mlynarski R, Sosnowski M, Mlynarska A, Tendera M. Computed tomography in patients with cardiac pacemakers: difficulties and solutions. Heart Vessels 2011; 27:300-6. [PMID: 21505855 DOI: 10.1007/s00380-011-0140-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 03/25/2011] [Indexed: 12/15/2022]
Abstract
The presence of cardiac pacemaker systems may significantly limit interpretation of multi-slice computed tomography (MSCT) images. In 80 patients (45 men; aged 69.5 ± 13.4) with previously implanted anti-arrhythmic devices, a 64-slice CT (Aquilion-64) was performed. In 61 patients (76.3%), ECG gating was used (coronaries visualization) and in 19 patients (23.7%) without ECG gating (not coronaries visualization). In all 19 patients without ECG gating MSCT images were diagnostic. In 37 (60.6%) patients of 61, there was no problem with gating process and image quality was diagnostic. In 24 (39.4%) with visible spikes in the ECG-gating group, there were difficulties in differentiating the R spike from an artificial spike (unipolar pacing) by MSCT software. In 15 patients (24.6%) after reprogramming, it was possible to obtain good quality images. In nine (14.7%) patients, it was not possible to reprogram devices due to old unipolar leads, but in two cases (3.3%), ECG gating was corrected manually and good image quality was obtained. In seven (11.5%) patients, it was not possible to perform ECG gating. The ECG gating process was identified as the main cause of the imaging problems. Bipolar leads working as bipolar pacing seem to be necessary to perform MSCT with ECG gating. A unipolar system lead may cause serious problems with reconstructions.
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Affiliation(s)
- Rafal Mlynarski
- Unit of Noninvasive Cardiovascular Diagnostics, Upper-Silesian Cardiology Center, ul. Ziolowa 45/47, 40-635, Katowice, Poland.
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Hirose M, Tachikawa K, Ozaki M, Umezawa N, Shinbo T, Kokubo K, Kobayashi H. X-ray radiation causes electromagnetic interference in implantable cardiac pacemakers. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 33:1174-81. [PMID: 20663069 DOI: 10.1111/j.1540-8159.2010.02846.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND X-rays are not thought to cause electromagnetic interference (EMI) in implantable cardiac pacemakers. However, x-ray radiation during computed tomography (CT) scanning has been reported to cause EMI in some implantable cardiac pacemakers. The objectives of this study were to identify the location within the pacemakers where x-ray radiation causes EMI and to investigate the association of EMI with the x-ray radiation conditions. METHODS We verified the location where x-ray radiation caused EMI using a CT scanner and conventional radiographic x-ray equipment. An inhibition test and an asynchronous test were performed using five types of implantable cardiac pacemakers. RESULTS X-ray radiation inhibited the pacing pulses of four types of implantable cardiac pacemakers when the body of each implantable cardiac pacemaker, containing a complementary metal-oxide semiconductor (CMOS), was scanned using a CT scanner. We confirmed that x-ray-induced EMI depends on the x-ray radiation conditions, that is, the tube voltage, tube current, x-ray dose, and direction of x-ray radiation, as well as the sensing thresholds of the implantable cardiac pacemakers. CONCLUSIONS X-ray radiation caused EMI in some implantable cardiac pacemakers, probably because the CMOS component was irradiated. The occurrence of EMI depended on the pacemaker model, sensing threshold of the pacemaker, and x-ray radiation conditions.
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Affiliation(s)
- Minoru Hirose
- Department of Medical Engineering and Technology, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan.
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Kalra N, Klewer SE, Raasch H, Sorrell VL. Update on tetralogy of Fallot for the adult cardiologist including a brief historical and surgical perspective. CONGENIT HEART DIS 2010; 5:208-19. [PMID: 20576040 DOI: 10.1111/j.1747-0803.2010.00402.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There has been a steady rise in the prevalence of severe congenital heart disease (CHD) in adults because of improved treatment and survival during childhood. This has resulted in a shift in CHD morbidity and mortality beyond 18 years of age. The healthcare community must be prepared to meet this new challenge. Adult cardiologists need to be aware of common CHD, such as tetralogy of Fallot (TOF), as they will encounter adults with this CHD in their practice. With routine monitoring, cardiac imaging, early intervention, and treatment as highlighted in this report, continued improvement in the long-term fitness and avoidance of late complications for adult TOF patient is anticipated.
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Affiliation(s)
- Nishant Kalra
- Division of Cardiology, Department of Internal Medicine, University of Arizona, Tucson, AZ 85724, USA.
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Palm A, Nilsson E, Herrnsdorf L. Absorbed dose and dose rate using the Varian OBI 1.3 and 1.4 CBCT system. J Appl Clin Med Phys 2010; 11:3085. [PMID: 20160695 PMCID: PMC5719770 DOI: 10.1120/jacmp.v11i1.3085] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 08/24/2009] [Accepted: 10/22/2009] [Indexed: 11/23/2022] Open
Abstract
According to published data, the absorbed dose used for a CBCT image acquisition with Varian OBI v1.3 can be as high as 100 mGy. In 2008 Varian released a new OBI version (v1.4), which promised to reduce the imaging dose. In this study, absorbed doses used for CBCT image acquisitions with the default irradiation techniques of Varian OBI v1.3 and v1.4 are measured. TLDs are used to derive dose distributions at three planes inside an anthropomorphic phantom. In addition, point doses and dose profiles inside a ‘stack’ of three CTDI body phantoms are measured using a new solid state detector, the CT Dose Profiler. With the CT Dose Profiler, the individual pulses from the X‐ray tube are also studied. To verify the absorbed dose measured with the CT Dose Profiler, it is compared to TLD. The image quality is evaluated using a Catphan phantom. For OBI v1.3, doses measured in transverse planes of the Alderson phantom range between 64 mGy and 144 mGy. The average dose is around 100 mGy. For OBI v1.4, doses measured in transverse planes of the Alderson phantom range between 1 mGy and 51 mGy. Mean doses range between 3‐35 mGy depending on CBCT mode. CT Dose Profiler data agree with TLD measurements in a CTDI phantom within the uncertainty of the TLD measurements (estimated SD ±10%). Instantaneous dose rate at the periphery of the phantom can be higher than 20 mGy/s, which is 10 times the dose rate at the center. The spatial resolution in v1.4 is not as high as in v1.3. In conclusion, measurements show that the imaging doses for default modes in Varian OBI v1.4 CBCT system are significantly lower than in v1.3. The CT Dose Profiler is proven fast and accurate for CBCT applications. PACS number: 87.53.Bn
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Affiliation(s)
- Asa Palm
- Sahlgrenska University Hospital, Deptartment of Medical Physics and Biomedical Engineering, Göteborg, Sweden.
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Gossman MS, Graves-Calhoun AR, Wilkinson JD. Establishing radiation therapy treatment planning effects involving implantable pacemakers and implantable cardioverter-defibrillators. J Appl Clin Med Phys 2009; 11:3115. [PMID: 20160685 PMCID: PMC5719785 DOI: 10.1120/jacmp.v11i1.3115] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Revised: 08/04/2009] [Accepted: 08/31/2009] [Indexed: 11/23/2022] Open
Abstract
Recent improvements to the functionality and stability of implantable pacemakers and cardioverter‐defibrillators involve changes that include efficient battery power consumption and radiation hardened electrical circuits. Manufacturers have also pursued MRI‐compatibility for these devices. While such newer models of pacemakers and cardioverter‐defibrillators are similar in construction to previously marketed devices – even for the recent MRI‐compatible designs currently in clinical trials – there is increased interest now with regard to radiation therapy dose effects when a device is near or directly in the field of radiation. Specifically, the limitation on dose to the device from therapeutic radiation beams is being investigated for a possible elevation in limiting dose above 200 cGy. We present here the first‐ever study that evaluates dosimetric effects from implantable pacemakers and implantable cardioverter‐defibrillators in high energy X‐ray beams from a medical accelerator. Treatment plan simulations were analyzed for four different pacemakers and five different implantable cardioverter‐defibrillators and intercompared with direct measurements from a miniature ionization chamber in water. All defibrillators exhibited the same results and all pacemakers were seen to display the same consequences, within only a a±1.8% deviation for all X‐ray energies studied. Attenuation, backscatter, and lateral scatter were determined to be −13.4%, 2.1% and 1.5% at 6 MV, and −6.1%, 3.1% and 5.1% at 18 MV for the defibrillator group. For the pacemaker group, this research showed results of −15.9%, 2.8% and 2.5% at 6 MV, and −9.4%, 3.4% and 5.7% at 18 MV, respectively. Limited results were discovered from scattering processes through computer modeling. Strong verification from measurements was concluded with respect to simulating attenuation characteristics. For IP and ICD leads, measured dose changes were less than 4%, existing as attenuation processes only, and invariant with regard to X‐ray energy. PACS number: 87.53.Bn, 87.53.Dq, 87.53.Tf, 87.66.Jj
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Affiliation(s)
- Michael S Gossman
- Tri-State Regional Cancer Center, Medical Physics Section, Ashland, Kentucky 41101, USA.
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Computed Tomography Scan and ICD Interaction. Case Rep Med 2009; 2009:189429. [PMID: 19888421 PMCID: PMC2771149 DOI: 10.1155/2009/189429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Accepted: 09/23/2009] [Indexed: 11/24/2022] Open
Abstract
Although it has been considered a safe procedure, computed tomography scanning uses
high doses of radiation and can cause malfunctioning in those patients with ICD when the radiation is directly incident on the device. We present a case of ventricular oversensing during a thoracic computed tomography.
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Pulver AF, Puchalski MD, Bradley DJ, Minich LL, Su JT, Saarel EV, Whitaker P, Etheridge SP. Safety and imaging quality of MRI in pediatric and adult congenital heart disease patients with pacemakers. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:450-6. [PMID: 19335853 DOI: 10.1111/j.1540-8159.2009.02304.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is a standard of care in evaluating many disease processes. Given concerns about device damage or movement, programming changes, lead heating, inappropriate pacing, and image artifact, MRI is contraindicated in pacemaker patients. Despite this, studies have demonstrated safety and efficacy of MRI in adults with acquired heart disease and endocardial pacing leads. We sought to evaluate MRI use in congenital heart disease (CHD) patients with predominantly epicardial pacing leads. METHODS From July 2007 to October 2008, MRI (1.5 Tesla) was performed in 11 patients without alternative imaging modality who were not pacemaker dependent or possessing abandoned leads. Pacing was disabled during MRI. An electrophysiologist monitored electrocardiogram and hemodynamic parameters throughout each study. Device and lead function were evaluated before and after MRI, and at subsequent clinic visits. RESULTS Eleven MRIs (four cardiac, seven noncardiac) were performed in eight patients. Mean patient age was 16.5 +/- 9.2 years (range 1.7-24.5) with five patients under the age of 16 years. Diagnoses included structural CHD in six patients and long QT syndrome and congenital heart block in one each. There were three dual- and five single- (three atrial, two ventricular) chamber devices, two endocardial, and nine epicardial leads. No inappropriate pacing or significant change in generator or lead parameters was noted. All MRI studies were of diagnostic quality. CONCLUSION Diagnostic quality MRI can be performed safely in nonpacemaker-dependent CHD patients with predominantly epicardial leads. Further studies will define safe practice measures in this population, as well as in CHD patients with pacemaker dependency.
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Affiliation(s)
- Aaron F Pulver
- Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah 84113, USA.
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Dunnick NR. Ensuring Patient Safety: A Summary of the 2008 Intersociety Conference. J Am Coll Radiol 2009; 6:230-4. [DOI: 10.1016/j.jacr.2008.11.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Indexed: 10/24/2022]
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