Example Radiation Oncology Policy for Managing Patients With Implanted Electronic Devices Other Than Implantable Cardiac Pacemakers or Defibrillators.

Abstract

This article describes a community-based hospital's policy for the management of patients with medical implanted electronic devices other than pacemakers or implanted cardiac defibrillators (ICDs). The policy may be adapted as needed for other radiation oncology groups requiring a practical solution for managing the care of patients with implanted devices, noting the need for changes for departments offering proton, neutron, heavy ion, or magnetic resonance-guided linear accelerator (MR-linac) treatment modalities. The policy was developed using a risk-based approach, with each patient's risk level determined based on the patient's dependence on the device, the anticipated dose to the device, and the type of treatment used. A similar approach is used for patients with pacemakers or ICDs, but this policy was designed to accommodate patients with other types of devices with care managed outside the department. Such devices include, but are not limited to, hepatic pumps, intrathecal pain pumps, neurostimulators, cochlear implants, and loop recorders. The resulting definitions, guidelines, and proposed workflow were presented at the institution's multidisciplinary radiation oncology quality assurance committee monthly meeting and adopted as department policy in 2022. Recommendations incorporated in the policy include levels of patient monitoring and timing of device interrogation to minimize the risk of device malfunction. The policy was written to guide the management of treatment of patients with a range of medical implanted electronic devices. This policy is currently in operation at a community-based hospital.