As the number of patients with implanted devices increases, radiation therapy clinics are seeing proportionally more patients with implanted devices. In this session, we will review and discuss how to manage those existing and emerging implanted devices. Commonly present devices in cancer patients include cardiac pacemaker, implanted cardiac defibrillator (ICD), hepatic pump, intrathecal pain pump, neurostimulator, cerebral shunt, cardiac-loop-recorder, spine hardware, cochlear implant, medi-port, tissue expanders, left ventricular assist device (LVAD). Three different classifications of implanted devices are made based on the effect of radiation: life-dependent, non-life-dependent but have adverse effects if overdosed, and devices without electronic circuits. Implanted devices that contain electronic circuits that would be life-dependent or have adverse effects if overdosed, include cardiac pacemakers, ICDs, programmable hepatic pumps, pain pumps, neurostimulators, loop recorders, and LVAD. Dose exposure to some of these devices needs to be calculated and minimized to assure continued healthy functioning. Treatment planning techniques should be chosen to reduce entry, exit and internal scatter dose. Lower energy photon beams should be used to decrease potential neutron contamination. Implanted devices without electronic circuits are less of a concern in terms of dose tolerances. If a patient is life-dependent on the implanted device, it is not recommended to treat the patient with proton therapy, especially in standalone centers with limited resources. For the management of pacing independent patients with implanted cardiac pacemakers, the radiotherapy team should confer with the patient’s cardiologist to discuss potential risks before delivering proton therapy. The presentations will review the management of patients with commonly seen implanted devices and summarize a workflow for identifying and planning when a patient has implanted devices.
1.To be familiar with the existing and emerging devices inside patients undergoing radiotherapy
2.To be able to classify implanted devices and appropriately manage the planning and delivery of radiation in patients for photons and protons with specific devices
3.To provide guidelines for some of the newer implanted devices, such as programmable hepatic pumps, intrathecal pain pumps, neurostimulators, cardiac loop recorders, cerebral shunts, tissue expanders, spine hardware, etc. in addition to the cardiac implanted devices discussed in the AAPM TG-203
Funding Support, Disclosures, and Conflict of Interest: Ashland Inc., the manufacturer of GafChromic film.
Radiation Therapy, Radiation Risk, Quality Control