Table 2.
Electron- and photon-EBRT dose recommendations and specifications indicated by the most common CIED manufacturers (17, 45).
| Manufacturer | Max PM dose | Max ICD dose | Max beam energy | Casing material | Lead Shielding of device | Battery chemistry (80–82) | Comments based on PT studies |
|---|---|---|---|---|---|---|---|
| Biotronik (83) | 2Gy | 2Gy | ≤10MV No direct beam to device |
Titanium | Yes | Li/MnO2
Li/SVO CFx |
Biotronik devices particularly ICDs and CRTs have had the highest number of software malfunction during PT (41) |
| St. Jude Medical (84) | No safe dose | No safe dose | Not specified Do not use ionising radiation in the proximity of an implanted device |
Titanium | Not specified | Li/SVO Li/SVO CFx |
Some PMs had software malfunctions (36, 39, 42) |
| Medtronic (85) | 5Gy | 1–5Gy Depending on the model |
≤10MV | Titanium | No (ineffective against neutrons | Li/SVO Li/SVO CFx |
Software errors have occurred in these devices (37, 39, 42). 5 ICDs had significant loss of battery capacity (hardware malfunction) (41) |
| Boston Scientific (86) | No safe dose limit (Maximum total dose of 2Gy used as a reference) |
No safe dose limit (Maximum total dose of 2Gy used as a reference) |
Not specified | Titanium | Yes Consider all available shielding options |
Li/MnO2
Li/SVO CFx |
Only 1 PM reported which had a critical software malfunction (41) |
PM, pacemaker; ICD, implantable cardioverter defibrillator; CRT, cardiac resynchronisation therapy device; PT, proton therapy; Li/MnO2, lithium-manganese oxide; Li/SVO, lithium-silver vanadium oxide; CFx, carbon monofluoride.