title: Proton dose perturbations caused by high-voltage leads from implanted cardioverter defibrillators.
abstract: An increasing number of patients undergoing proton radiotherapy have cardiac implantable electrical devices (CIEDs). We recently encountered a situation in which a high-voltage coil on a lead from an implanted cardiac defibrillator was located within the clinical treatment volume for a patient receiving proton radiotherapy for esophageal cancer. To study the effects of the lead on the dose delivery, we placed a high-Z CIED lead at both the center and the distal edge of a clinical spread-out Bragg peak (SOBP) in a water phantom, in both a stationary position and with the lead moving in a periodic pattern to simulate cardiorespiratory movement. We then calculated planned doses using a commercial proton treatment planning system (TPS), and compared them with the doses delivered in the phantom, measured using radiographic film. Dose profiles from TPS-calculated and measured dose distributions showed large pertubrations in the delivered proton dose in the vicinity of the CIED lead when it was not moving. The TPS predicted perturbations up to 20% and measurements revealed perturbations up to 35%. However, the perturbations were less than 3% when the lead was moving. Greater dose perturbations were seen when the lead was placed at the distal edge of the SOBP than when it was placed in the center of the SOBP. We conclude that although cardiorespiratory motion of the lead mitigates some of the perturbations, the effects of the leads should be considered and steps taken to reduce these effects during the treatment planning process.
authors: Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
authors: Landon S
authors: LS
authors: Wootton
authors: Jerimy C
authors: JC
authors: Polf
authors: Stephen
authors: S
authors: Peterson
authors: Jeff
authors: J
authors: Wilkinson
authors: Marc A
authors: MA
authors: Rozner
authors: Peter A
authors: PA
authors: Balter
authors: Sam
authors: S
authors: Beddar
mesh_terms: D017147:Defibrillators, Implantable; D004938:Esophageal Neoplasms / Q000503:physiopathology / Q000532:radiotherapy*; D006801:Humans; D010138:Pacemaker, Artificial; D019047:Phantoms, Imaging; D011522:Protons; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*
chemical_list: D011522:Protons