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Measuring dose from radiotherapy treatments in the vicinity of a cardiac pacemaker

  • Samuel C. Peet
    Correspondence
    Corresponding author at: Royal Brisbane and Women’s Hospital, Butterfield Street, Herston, QLD 4029, Australia.
    Affiliations
    Royal Brisbane and Women’s Hospital, Butterfield Street, Herston, QLD 4029, Australia

    School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, GPO Box 2434, Brisbane, QLD 4001, Australia
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  • Rachael Wilks
    Affiliations
    Royal Brisbane and Women’s Hospital, Butterfield Street, Herston, QLD 4029, Australia
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  • Tanya Kairn
    Affiliations
    Genesis Cancer Care Queensland, 1/40 Chasely Street, Auchenflower, QLD 4066, Australia

    School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, GPO Box 2434, Brisbane, QLD 4001, Australia
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  • Scott B. Crowe
    Affiliations
    Royal Brisbane and Women’s Hospital, Butterfield Street, Herston, QLD 4029, Australia

    School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, GPO Box 2434, Brisbane, QLD 4001, Australia
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Published:November 21, 2016DOI:https://doi.org/10.1016/j.ejmp.2016.11.010

      Highlights

      • The delivered dose was unevenly distributed in the vicinity of a cardiac device.
      • Treatment planning systems were generally poor at estimating the pacemaker dose.
      • Skin dose exceeded pacemaker dose in head and neck treatments, but not in lung cases.
      • Simple square field reference data is useful even for more complex treatments.

      Abstract

      This study investigated the dose absorbed by tissues surrounding artificial cardiac pacemakers during external beam radiotherapy procedures. The usefulness of out-of-field reference data, treatment planning systems, and skin dose measurements to estimate the dose in the vicinity of a pacemaker was also examined. Measurements were performed by installing a pacemaker onto an anthropomorphic phantom, and using radiochromic film and optically stimulated luminescence dosimeters to measure the dose in the vicinity of the device during the delivery of square fields and clinical treatment plans. It was found that the dose delivered in the vicinity of the cardiac device was unevenly distributed both laterally and anteroposteriorly. As the device was moved distally from the square field, the dose dropped exponentially, in line with out-of-field reference data in the literature. Treatment planning systems were found to substantially underestimate the dose for volumetric modulated arc therapy, helical tomotherapy, and 3D conformal treatments. The skin dose was observed to be either greater or lesser than the dose received at the depth of the device, depending on the treatment site, and so care should be if skin dose measurements are to be used to estimate the dose to a pacemaker. Square field reference data may be used as an upper estimate of absorbed dose per monitor unit in the vicinity of a cardiac device for complex treatments involving multiple gantry angles.

      Keywords

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