Author: Russell E. Kincaid, Weidong Li, Tarun Kanti Podder, Peter K. Taylor, Vincent Wu 👨🔬
Affiliation: SUNY Upstate Medical University 🌍
Purpose: An increasing number of cancer patients are presented at radiotherapy clinics with implanted electronic devices other than cardiac implanted electronic devices (CIEDs). Unlike with CIEDs, there is hardly any clinical guidelines for radiotherapy with these non-CIEDs. The aim of this study is to identify the type and frequency of these non-CIEDs and investigate the available guidelines, if there are any.
Methods: Over the past two years, information for patients undergoing radiotherapy in our department was collected and categorized according to type of non-CIEDs, manufacturer/model, treatment site, and dose regimen. Documentation, including manuals and EMI warnings for the devices, were used to gather recommendations about cautions during radiotherapy. Direct communication with the manufacturer, through phone or emails, were also used when radiotherapy was not mentioned in the documentation.
Results: So far, we have encountered six types of non-CIEDs by seven manufacturers. These are loop recorder (n=6) by Medtronic and Biotronik, Holter epatch (n=1) by Phillips, glucose monitor (n=2) by Dexcom and Abbott, insulin pump (n=1) by Tantem Diabetes Care, nerve stimulator (n=1) for bladder control by Medtronic, and spinal cord stimulator (n=1) by Boston Scientific. A majority of the non-CIEDs was the loop recorder (50%), followed by glucose monitor (17%). Recommendations from the manufacturer ranges from ‘no radiation to the device’ to ‘not in the beam’, also to some specifics such as ‘use no more than 10MV and cumulated dose less than 5Gy’, i.e., similar to CIEDs. Some manufacturers suggested removing the non-CIEDs or turning them off during radiotherapy.
Conclusion: Cautions should be taken when treating patients with non-CIED electronic devices. Due to the lack of proper guidelines, we, in our clinic, follow the manufacturer’s/vendor’s recommendations and the CIED policy as much as feasible. A systematic study and development of clinical guidelines for these non-CIEDs are warranted.