According to guidelines, carbon-ion beam therapy is considered to carry a high safety risk for patients with cardiac implantable electronic devices (CIEDs), although the actual impacts remain unclear. In this study, we investigated the safety of carbon-ion beam therapy in patients with CIEDs. Patients with CIEDs who underwent carbon-ion therapy at Gunma University Heavy Ion Medical Center between June 2010 and December 2019 were identified and investigated for abnormalities in the operation of their CIEDs, such as oversensing and resetting during irradiation, and abnormalities in operation after treatment. In addition, the risk of irradiation from carbon-ion beam therapy was evaluated by model simulations. Twenty patients (22 sites) with CIEDs were identified, 19 with pacemakers and one with an implantable cardioverter-defibrillator (ICD). Treatments were completed without any problems, except for one case in which the treatment was discontinued because of worsening of the primary disease. Monte Carlo simulation indicated that the carbon beam irradiation produced neutrons at a constant and high level in the irradiation field. Nevertheless, with the distances between the CIEDs and the irradiation fields in the analyzed cases, the quantity of neutrons at the CIEDs was lower than that within the irradiation. Although carbon-ion beam therapy can be safely administered to patients with CIEDs, it is advisable to perform the therapy with sufficient preparation and backup devices because of the risks involved.
SummaryInterventional radiology (IVR) is a technique using image guidance such as X-ray fluoroscopy to perform diagnostic and therapeutic procedures. It is widespread, and its use continues to increase. Radiofrequency catheter ablation (RFCA) has a long fluoroscopy time, and ablation procedures may be repeated in a single session. The entrance skin dose may reach several Gy, but information on radiation dose of actual procedures is limited. We conducted a survey on RFCA to acquire general information on how the procedures are performed in local institutions, including patient radiation dose in the Kanto area. 43% (33/77 institutions) of institutions to which we sent written questionnaires returned completed forms. Ablation for atrial fibrillation had the longest average fluoroscopy times (100.8 min) and average procedure times (228 min), and average air kerma at the interventional reference point (1173.6 mGy). Percutaneous coronary intervention and RFCA may cause skin injury, which suggests the continued need for radiation safety management.
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