Implanted Electronic Device Management in a Pencil-Beam Scanning Proton-Therapy Clinic.

Abstract

This study aims to present single-institution workflows and experience for treating patients with implanted electronic devices (IEDs) at a high-volume proton pencil-beam scanning clinic. A multidisciplinary group was formed when opening the proton clinic to assess the risk of IEDs, primarily from neutron damage, and the potential for patient harm under device failure. A policy was developed for management of cardiac (CIEDs) and medical IEDs (MIEDs), including endocrinology devices, neurostimulators, auditory-assist devices, and infusion pumps. Patients treated with IEDs were assessed for trends and failures. A workflow was developed to identify devices and communicate potential action steps at 4 stages of treatment planning and delivery. Guidelines on-treatment beam selection and image guidance were shared between all device types. Patients with CIED received heart rate monitoring during each treatment and regular device interrogations, while guidance for MIEDs varied by function and risk of harm. A total of 294 proton radiation therapy courses were delivered to patients with IEDs. Of 144 courses delivered to patients with CIED devices, 5 had recoverable resets with no major failures. Risk-based guidelines were developed and refined to safely treat patients' CIEDs and MIEDs.