A multicenter dosimetry study to evaluate the imaging dose from Elekta XVI and Varian OBI kV-CBCT systems to cardiovascular implantable electronic devices (CIEDs)

Aslian, Hossein; Delana, Anna; Kaiser, Stefano Ren; Moretti, E.; Foti, C.; Bregant, P.; Denaro, Mario de; Longo, F.; Severgnini, Mara

doi:10.1016/j.ejmp.2018.10.013

Cited by 5 publications

(4 citation statements)

References 32 publications

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“…However, because increasing the cumulative dose increases the risk of failure, the consensus is that the cumulative dose received by CIEDs should be kept as low as possible. 15,24 In the new AAPM guideline, 17 CIED patients are risk-categorized not only on the basis of the CIED cumulative dose and pacing dependency 15,24 but also on the basis of neutrons present;…”

Section: Similar Results Were Obtained In Repeated Experiments Withmentioning

confidence: 99%

“…On top, a 1-cm-thick slab was used to simulate the patient's tissue. 15 The total size of the solid slab phantom was 30 cm × 30 cm × 15 cm. tively.…”

Section: B2 | Interrogation Before During and After Radiationmentioning

confidence: 99%

“…[8][9][10] However, guidelines 11,12 and reviews 9,13 mainly address the management of patients with CIEDs undergoing conventional radiotherapy. 14,15 The first recommendation from the AAPM on the management of radiotherapy patients with CIEDs dates back to 1994 (TG-34). 16 During the revision of this paper, a new AAPM practice guideline to manage CIED patients receiving radiotherapy (TG-203) has been published.…”

Section: Introductionmentioning

confidence: 99%

“…These features are a) higher dose per fraction in SBRT, which might result in a higher dose per fraction to the CIED, b) SBRT-dedicated treatment technologies (e.g., CyberKnife, Gamma-Knife, and VERO), c) different techniques to achieve conformal doses (such as multiple static fields/arcs and noncoplanar geometries), d) different out-of-field doses, 18 higher monitor units (MUs) in modulated techniques (e.g., intensity-modulated radiotherapy (IMRT)-SBRT and volumetric-modulated arc therapy (VMAT)-SBRT), e) electromagnetic field fluctuations in SBRT that are specific to repeated beam holds (e.g., step-andshoot IMRT and gating techniques) or nonconventional linac-based technologies (e.g., continuous motion of the couch and gantry in tomotherapy with a shorter source-to-axis distance (SAD = 85 cm) instead of the usual 100 cm in conventional accelerators or the proximity/motion of CyberKnife linac relative to patients compared to conventional linac treatments), and f) extensive use of imageguided radiotherapy (IGRT). 14,15 In the context of high dose per fraction, SBRT flattening filter-free (FFF) beams have gained popularity. [19][20][21] Flattening filterfree beams have several unique features, including a lower outof-field dose, a sharper penumbra, and less head scatter, which are potentially advantageous characteristics for patients with CIEDs.…”

Section: Introductionmentioning

confidence: 99%

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The effect of stereotactic body radiotherapy (SBRT) using flattening filter‐free beams on cardiac implantable electronic devices (CIEDs) in clinical situations

Aslian

Kron

Watts

et al. 2020

J Applied Clin Med Phys

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Purpose: This study focused on determining risks from stereotactic radiotherapy using flattening filter-free (FFF) beams for patients with cardiac implantable electronic device (CIEDs). Two strategies were employed: a) a retrospective analysis of patients with CIEDs who underwent stereotactic radiosurgery (SRS)/SBRT at the Peter MacCallum Cancer Centre between 2014 and 2018 and b) an experimental study on the impact of FFF beams on CIEDs.Methods: A retrospective review was performed. Subsequently, a phantom study was performed using 30 fully functional explanted CIEDs from two different manufacturers. Irradiation was carried out in a slab phantom with 6-MV and 10-MV FFF beams. First, a repetition-rate test (RRT) with a range of beam pulse frequencies was conducted. Then, multifraction SBRT (48 Gy/4 Fx) and single-fraction SBRT (28 Gy/1 Fx) treatment plans were used for lung tumors delivered to the phantom.Results: Between 2014 and 2018, 13 cases were treated with an FFF beam (6 MV, 1400 MU/min or 10 MV, 2400 MU/min), and 15 cases were treated with a flattening filter (FF) beam (6 MV, 600 MU/min). All the devices were positioned outside the treatment field at a distance of more than 5 cm, except for one case, and no failures were reported due to SBRT/SRS. In the phantom rep-rate tests, inappropriate sensing occurred, starting at a rep-rate of 1200 MU/min. Cardiac implantable electronic device anomalies during and after delivering VMAT-SBRT with a 10-MV FFF beam were observed. Conclusions:The study showed that caution should be paid to managing CIED patients when they undergo SBRT using FFF beams, as it is recommended by AAPM TG-203. Correspondingly, it was found that for FFF beams although there is small risk from dose-rate effects, delivering high dose of radiation with beam energy greater than 6 MV and high-dose rate to CIEDs positioned in close vicinity of the PTV may present issues.---

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Section: Similar Results Were Obtained In Repeated Experiments Withmentioning

confidence: 99%

“…On top, a 1-cm-thick slab was used to simulate the patient's tissue. 15 The total size of the solid slab phantom was 30 cm × 30 cm × 15 cm. tively.…”

Section: B2 | Interrogation Before During and After Radiationmentioning

confidence: 99%