Since then, there have been a number of studies undertaken to further the understanding of cardiac implantable electronic devices (CIEDs) and their vulnerability in a radiotherapy environment. Over the last few decades, the complexity of the devices has escalated dramatically, increasing the radiosensitivity of the implants. Guidance was needed to offset a lack of clarity and consistency from vendors regarding use of radiation therapy for patients with CIEDs, and a large gap between manufacturer recommendations and clinical policy was evident.
“The task group set out to create a set of guidelines for every particular user given their own locale, regardless of resources, to shape the environment that they want to have in their practice.” – Dimitris Mihailidis, co-author of TG-203
CIED Damage Pathways and Measurement Recommendations
Patient Risk Categories
- Dependency status
- Neutron production from treatment modality/energy
- Cumulative dose to the device based on treatment planning system estimate (if device is <3cm of field edge) or measured dose
Table VI of TG-203
Table VII of TG-203
Treatment Considerations and Implementation
The task group is written to provide meaningful structure and resources to improve the management of patients with CIEDs. To that end, the report includes clinical flowchart examples as well as a patient management checklist.
Implementation of the new guidelines requires a multidisciplinary approach with efforts from major players in the radiation therapy department as well as complementary providers such as cardiologists. According to Dimitris Mihailidis, co-author of the report, “If you don’t already have open lines of communication with cardiology, it is important to start building those channels. Having the radiation oncologist reach out to the cardiologist may be the most effective means of facilitating this communication, though nursing or physics staff could also play a role.” He goes on to recommend that departments “bring vendor contacts on board as an adjunct to patient care. Most major vendors like Medtronic or St. Jude’s have local contacts that can provide helpful resources and assistance with device-dependent patients. Medtronic has a nice online learning resource for using magnets, for example.”