15
Management of Patients with a
CIED Undergoing Radiation Therapy
Table 11. Secondary Neutron-Producing Radiation in Various
Commonly Used Radiation Modalities
Radiation modality
No relevant
neutron production
Marginal
neutron
production
Clinically
significant
neutron
production
Photons <10 MV 10 MV >10 MV
Electrons <20 MeV ≥20 MeV
Protons All clinically
used energies
Radioactive isotopes
(cobalt-60, brachytherapy)
All clinically used
modalities
Table 12. Recommendations and Protocol for the
Management of Patients with a CIED Undergoing
Radiation Therapy
Recommendations COR LOE
Prior to the initiation of radiation treatment, a complete CIED
evaluation should be performed and the treatment team should
be informed of:
a. Whether the device is a PM or ICD
b. Whether the patient is pacing-dependent
c. The minimum programmed pacing rate
d. The maximum programmed tracking and sensor rates.
I B-NR
Non-neutron-producing treatment is preferred over neutron-
producing treatment in patients with a CIED to minimize the
risk of device reset.
I B-NR
Perform weekly complete CIED evaluations for patients
undergoing neutron-producing treatment.
I B-NR
A complete CIED evaluation should be performed at the
conclusion of the course of radiation therapies.
I B-NR
Continuous visual and voice contact is recommended during
each treatment fraction.
I C-EO
CIED relocation is recommended if its current location will
interfere with adequate tumor treatment.
I C-EO
It might be reasonable to perform a complete CIED evaluation
weekly for patients who are pacing-dependent and undergoing
non-neutron-producing treatment.
IIb B-NR
CIED relocation is NOT recommended for devices receiving a
maximum cumulative incident dose of <5 Gy.
III
(Harm)
B-NR
