Systematic review of physical and dosimetric criteria for managing CIEDs in radiotherapy: A medical physicist's perspective.

چکیده اصلی

AIM: Current radiotherapy (RT) guidelines for Cardiac Implantable Electronic Devices (CIEDs) are largely based on clinical management strategies and retrospective reports. This systematic review adopts a medical physics perspective to provide a critical, quantitative analysis of the technical evidence required for developing robust safety action plans. MATERIALS AND METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search was conducted (January 2014-December 2024) across five major databases. Sixteen physicists from the Associazione Italiana di Fisica Medica e Sanitaria (AIFM) Working Group (WG) performed a double-review and standardized data extraction, focusing on physics-specific variables for the irradiation of Left Ventricular Assist Devices (LVADs), Pacemakers (PMs), and Implantable Cardioverter-Defibrillator (ICD) devices. Data were grouped into five topics: photon/electron RT, hadron therapy, modeling RT effects (Treatment Planning System [TPS]/Monte Carlo [MC]), imaging, and specific considerations regarding Magnetic Resonance Imaging Linac (MRI-Linac) systems. The Malfunction Rate (MR)-the percentage of devices with a clinically relevant malfunction-was calculated, and a Z-test was carried out to highlight safer irradiation conditions. Additionally, a narrative synthesis was performed. RESULTS: Of the 60 selected articles, 47 were co-authored by physicists. The studies considered a total of 1769 real devices, while 13 studies reported on virtual devices (i.e., simulations, electronics, or measurements only). Reported irradiation beams included photons (encompassing Intra-Operative RadioTherapy [IORT], Total Body Irradiation [TBI], and Flattening Filter Free [FFF] beams), electrons, protons, and carbon ions. Thirty-seven manuscripts investigated CIED malfunctions, yielding an overall MR of 12.6%. The MR was significantly lower for devices irradiated under scatter conditions and when non-neutron-producing beams were used. Information on the entire RT process (imaging, dose calculation, planning, and irradiation) was analyzed, and a flowchart was developed to guide medical physicists in their daily clinical practice. CONCLUSION: The review concludes that the medical physicist's role is non-negotiable in developing and implementing advanced planning and dosimetry strategies to prevent CIED malfunction and ensure patient safety.

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