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The degree of translational and rotational movement of implanted pacemakers and cardioverter-defibrillators on coronal plane images in patients treated with radiotherapy for lung malignancy.
Medical Dosimetry ( IF 1.2 ) Pub Date : 2020-05-04 , DOI: 10.1016/j.meddos.2020.03.001
Loukas A Georgiou 1
Affiliation  

Malfunction of both implantable cardiac pacemakers and cardioverter-defibrillators as a result of exposure to therapeutic radiation is a known risk in radiation therapy. Although guidelines are available to minimize this risk for low energy beams, the guidelines rely on the estimated doses of ionizing radiation received by the device. Implicit in this calculation is that there is minimal day-to-day movement in the position of the device. However, with the exception of the leads in some cases, the devices are not intentionally sewn to the surrounding tissue but simply placed in a pocket in the prepectoral fascial compartment. This surgical technique may allow for movement of the device which may result in differences to the actual dose received during a course of treatment. The author is unaware of prior studies that have examined this specific concern. Consequently, a total 12 patients with implantable pacemakers or cardioverter-defibrillators receiving radiotherapy were reviewed with a total of 206 daily treatment images available for analysis. Although, there was a large range in the medial-lateral and the superior-inferior position of these devices, the mean position of these devices differed only by 2 mm and 2 mm respectively when compared to the first day's images. Similarly, there was a large range in the daily rotation of the device but the mean difference in rotation was only 2 degrees in the counter-clockwise direction. However, some devices were noted to move up to 3.5 cm in the medial-lateral direction, 5.0 cm in the cranial-caudal direction, and to undergo up to 43 degrees of rotation in the counter-clockwise direction. Therefore, care must be taken when these devices are close to the edge of a treatment field.



中文翻译:

肺部恶性肿瘤放疗患者冠状平面图像上植入的起搏器和心律转复除颤器的平移和旋转运动程度。

由于暴露于治疗辐射而导致植入式心脏起搏器和心律转复除颤器发生故障是放射治疗中的一个已知风险。虽然指南可用于将低能量束的这种风险降至最低,但指南依赖于设备接收到的电离辐射的估计剂量。该计算隐含着设备位置的日常移动最小。然而,在某些情况下,除了引线之外,这些装置并不是有意缝在周围组织上,而是简单地放置在胸前筋膜隔室的口袋中。这种手术技术可以允许装置移动,这可能导致在治疗过程中接收到的实际剂量的差异。作者不知道先前的研究已经审查了这一具体问题。因此,对总共 12 名接受放疗的植入式起搏器或心律转复除颤器患者进行了审查,每天共有 206 张治疗图像可供分析。尽管这些装置的内外侧和上下位置有很大的范围,但与第一天的图像相比,这些装置的平均位置分别仅相差 2 毫米和 2 毫米。同样,设备的日常旋转范围也很大,但逆时针方向的平均旋转差异仅为 2 度。然而,一些设备被注意到在内侧-外侧方向移动高达 3.5 厘米,在头尾方向移动 5.0 厘米,并在逆时针方向上进行最多 43 度的旋转。因此,当这些设备靠近治疗区域的边缘时,必须小心。

更新日期:2020-05-04
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