[OA177] Contribution of the medical physicist to the italian consensus document on management of patients with cardiac implantable devices (CIED) undergoing radiotherapy and future development from aifm wotking group

Severgnini, Mara; Menegotti, L.; Delana, Anna; Malatesta, T.; Quattrocchi, M.; Aslian, Hossein; Pietrobon, Francesca; Andreoli, S.; Cattani, Federica; Kaiser, Stefano Ren; Moretti, Elena; Foti, C.; Falco, M.D.; Guerriero, Francesca; Recanello, Sonia; Valentini, A.; Stasi, M.

doi:10.1016/j.ejmp.2018.06.249

Cited by 3 publications

(2 citation statements)

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“…TPS dose calculation accuracy in the out-of-field region has already been investigated [12][13][14][15][16] but specific TPSs dose error estimation in proximity of a high-density object and in particular relative to CIED structures have not yet been performed [17]. As medical physicists usually consider dose volume histograms (DVH) to estimate the maximum and mean dose received by CIEDs, DVH dose calculation errors must be evaluated too.…”

Section: Introductionmentioning

confidence: 99%

Dose calculation accuracy in proximity of a pacemaker: A multicenter study with threecommercial treatment planning systems

et al. 2020

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This study compares Treatment Planning System (TPS) out of field dose calculation on a pacemaker (PMK) during external beam radiotherapy treatment. We consider four TPSs (Elekta-Monaco, Oncentra-Masterplan and two Philips-Pinnacle3) commissioned for two linacs (Elekta Sinergy and Varian Clinac) delivering two test beams (a highly modulated one and a square field) and two clinical breast plans. To calculate and measure dose to a PMK we built a Real Water3 phantom with a PMK embedded in it. Measures are performed with thermoluminescent dosimeters and Mosfet dosimeters. We evaluate differences between TPS calculated values for the dose to the PMK (both point dose and dose-volume histogram parameters) when the PMK is positioned in the first 10 cm outside the radiation fields. TPS calculation accuracy is evaluated comparing such values with measures. Differences in TPS calculations are on average 3.5 cGy Gy -1 for the modulated beam, and always lower than 2 cGy Gy -1 for the square beam. TPS dose calculation depends mostly on the TPS algorithm and model rather than the linac commissioned. TPSs considered show different degrees of calculation accuracy. In the first 4 cm to the field edge three out of four TPSs are in good agreement with measurements in the square beam, but only one keeps the agreement in the modulated beam: the others show over and underestimations up to +20% − 40%. The same accuracy is found considering a homogeneous phantom. Our results confirm what reported in previous studies and highlight the impact of TPS commissioning.

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Section: Introductionmentioning

confidence: 99%

Dose calculation accuracy in proximity of a pacemaker: A multicenter study with threecommercial treatment planning systems

et al. 2020

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“…With the widespread implementation of advanced RT technologies and techniques, including SBRT treatments with FFF beams, the need to consider the different challenges of these techniques when managing patients with CIEDs has arisen 14,37. TG 203 and other guidelines highly recommended that direct irradiation of the device should be avoided.…”

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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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Multicentre investigation of neutron contamination at cardiac implantable electronic device (CIED) location due to high-energy photon beams using passive detectors and Monte Carlo simulations

Mele,

Aslian,

Bolzonella

et al. 2023

Eur. Phys. J. Plus

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Radiotherapy treatments involving LINACs operating at accelerating potentials >10 MV generate (photo)neutrons which deliver dose to patients also outside the target volume. This effect is particularly relevant for patients with cardiac implantable electronic devices (CIEDs), which can be damaged by the therapeutic irradiation. In the last few years, there has been a rising interest in this issue, and it seems that damage to CIEDs is primarily associated with the thermal component of the photoneutron field. In particular, a recent study led by Politecnico di Milano considered CIEDs from various manufacturers and showed that some of these devices can be damaged after an irradiation with a thermal neutron fluence of about $$10^{9}\hbox { cm}^{-2}$$ 10 9 cm - 2 . The present work results from a collaboration among Politecnico di Milano, the University of Pisa, the University of Trieste and three Italian hospitals located in Lucca, Trieste and Varese, respectively, and it is primarily aimed at evaluating the thermal neutron fluence in CIED region for some high-energy treatments delivered at 15 and 18 MV and to determine whether it is comparable to the critical value given above, which has been experimentally determined to be potentially harmful for CIEDs. Thermal neutron fluence was measured through CR-39 detectors and TLDs, which were housed inside a BOMAB-like phantom mimicking the patient’s trunk. The experimental sessions involved two models of LINAC, Varian Clinac DHX (Varese hospital) and Elekta Synergy (Lucca and Trieste hospitals). The experimental results show that the treatments considered in this study can lead to a thermal neutron fluence in the cardiac region comparable to the critical value. Furthermore, detailed Monte Carlo geometries for the facilities involved in this project were developed with the MCNP code (v. 6.2), and they were tested by comparing simulation results to measurements considering some benchmark irradiation plans. Bubble detectors were also employed for fast neutron fluence measurements to be compared to simulation outputs. These computational models stand out as promising tools for the investigations required in this work, and they can be used for further studies also extending their use to analogous facilities hosting the same models of LINACs.

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[OA177] Contribution of the medical physicist to the italian consensus document on management of patients with cardiac implantable devices (CIED) undergoing radiotherapy and future development from aifm wotking group

Cited by 3 publications

References 0 publications

Dose calculation accuracy in proximity of a pacemaker: A multicenter study with threecommercial treatment planning systems

Dose calculation accuracy in proximity of a pacemaker: A multicenter study with threecommercial treatment planning systems

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

Multicentre investigation of neutron contamination at cardiac implantable electronic device (CIED) location due to high-energy photon beams using passive detectors and Monte Carlo simulations

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