Prog Med Phys.  2019 Dec;30(4):150-154. 10.14316/pmp.2019.30.4.150.

The Accuracy of the Calculated Dose for a Cardiac Implantable Electronic Device

• Sung J
• Son J
• Park JM
• Kim JI
• Choi CH

• KMID: 2468176
• DOI: http://doi.org/10.14316/pmp.2019.30.4.150

Abstract

The objective of this study is to monitor the radiation doses delivered to a cardiac implantable electronic device (CIED) by comparing the absorbed doses calculated by a commercial treatment planning system (TPS) to those measured by an in vivo dosimeter. Accurate monitoring of the radiation absorbed by a CIED during radiotherapy is necessary to prevent damage to the device. We conducted this study on three patients, who had the CIED inserted and were to be treated with radiotherapy. Treatment plans were generated using the Eclipse system, with a progressive resolution photon optimizer algorithm and the Acuros XB dose calculation algorithm. Measurements were performed on the patients using optically stimulated luminescence detectors placed on the skin, near the CIED. The results showed that the calculated doses from the TPS were up to 5 times lower than the measured doses. Therefore, it is recommended that in vivo dosimetry be conducted during radiotherapy for CIED patients to prevent damage to the CIED.

Keyword

In vivo dosimetry; Arrhythmia; Cardiac; Clinical study

MeSH Terms

Arrhythmias, Cardiac
Clinical Study
Humans
Luminescence
Radiotherapy
Skin

Figure

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  Fig. 1 Position of the cardiac implantable electronic device (CIED), planning target volume (PTV), and optically stimulated luminescence detector (OSLD) in the case of volumetric modulated arc therapy (VMAT) and VMAT-stereotactic ablative radiotherapy (SABR) with CIED.

Reference

1. Makkar A, Prisciandaro J, Agarwal S, Lusk M, Horwood L, Moran J, et al. Effect of radiation therapy on permanent pacemaker and implantable cardioverter-defibrillator function. Heart Rhythm. 2012; 9:1964–1968.

2. Last A. Radiotherapy in patients with cardiac pacemakers. Br J Radiol. 1998; 71:4–10.

3. Zaremba T, Jakobsen AR, Søgaard M, Thøgersen AM, Riahi S. Radiotherapy in patients with pacemakers and implantable cardioverter defibrillators: a literature review. Europace. 2015; 18:479–491.

4. Hudson F, Coulshed D, D'Souza E, Baker C. Effect of radiation therapy on the latest generation of pacemakers and implantable cardioverter defibrillators: a systematic review. J Med Imaging Radiat Oncol. 2010; 54:53–61.

5. Yan H, Guo F, Zhu D, Stryker S, Trumpore S, Roberts K, et al. On the use of bolus for pacemaker dose measurement and reduction in radiation therapy. J Appl Clin Med Phys. 2018; 19:125–131.

6. Peet SC, Wilks R, Kairn T, Crowe SB. Measuring dose from radiotherapy treatments in the vicinity of a cardiac pacemaker. Phys Med. 2016; 32:1529–1536.

7. Hurkmans CW, Scheepers E, Springorum BG, Uiterwaal H. Influence of radiotherapy on the latest generation of pacemakers. Radiother Oncol. 2005; 76:93–98.

8. Sundar S, Symonds RP, Deehan C. Radiotherapy to patients with artificial cardiac pacemakers. Cancer Treat Rev. 2005; 31:474–486.

9. Marbach JR, Sontag MR, Van Dyk J, Wolbarst AB. Management of radiation oncology patients with implanted cardiac pacemakers: report of AAPM Task Group No. 34. American Association of Physicists in Medicine. Med Phys. 1994; 21:85–90.

10. Mak GS, Truong QA. Cardiac CT: imaging of and through cardiac devices. Curr Cardiovasc Imaging Rep. 2012; 5:328–336.

11. Hirschl DA, Jain VR, Spindola-Franco H, Gross JN, Haramati LB. Prevalence and characterization of asymptomatic pacemaker and ICD lead perforation on CT. Pacing Clin Electrophysiol. 2007; 30:28–32.

12. Ghafarian P, Aghamiri SM, Ay MR, Rahmim A, Schindler TH, Ratib O, et al. Is metal artefact reduction mandatory in cardiac PET/CT imaging in the presence of pacemaker and implantable cardioverter defibrillator leads? Eur J Nucl Med Mol Imaging. 2011; 38:252–262.

13. Farhood B, Ghorbani M. Dose calculation accuracy of radiotherapy treatment planning systems in out-of-field regions. J Biomed Phys Eng. 2019; 9:133–136.

14. Mahmoudi G, Farhood B, Shokrani P, Amouheidari A, Atarod M. Evaluation of the photon dose calculation accuracy in radiation therapy of malignant pleural mesothelioma. J Cancer Res Ther. 2018; 14:1029–1035.

15. Schneider U, Hälg RA, Hartmann M, Mack A, Storelli F, Joosten A, et al. Accuracy of out-of-field dose calculation of tomotherapy and cyberknife treatment planning systems: a dosimetric study. Z Med Phys. 2014; 24:211–215.

16. Howell RM, Scarboro SB, Kry SF, Yaldo DZ. Accuracy of out-of-field dose calculations by a commercial treatment planning system. Phys Med Biol. 2010; 55:6999–7008.

17. Huang JY, Followill DS, Wang XA, Kry SF. Accuracy and sources of error of out-of field dose calculations by a commercial treatment planning system for intensity-modulated radiation therapy treatments. J Appl Clin Med Phys. 2013; 14:4139.

18. Almond PR, Biggs PJ, Coursey BM, Hanson WF, Huq MS, Nath R, et al. AAPM's TG-51 protocol for clinical reference dosimetry of high-energy photon and electron beams. Med Phys. 1999; 26:1847–1870.

19. Kry SF, Smith SA, Weathers R, Stovall M. Skin dose during radiotherapy: a summary and general estimation technique. J Appl Clin Med Phys. 2012; 13:3734.