SynthesisJournal of applied clinical medical physics2026
Systematic review of physical and dosimetric criteria for managing CIEDs in radiotherapy: A medical physicist's perspective.
Synthesis in Journal of applied clinical medical physics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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16 authors.
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Abstract
aimCurrent 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
methodsFollowing 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.
resultsOf 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.
conclusionThe 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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