How do you approach cranial radiotherapy in a patient with a cochlear implant?

There are a number of studies that show that cochlear implants can tolerate high doses of radiation. For doses that we typically use, there does not appear to be a major decline in performance when exposed to radiation, either with conventionally fractionated doses or SRS doses. https://www.ncbi.nlm.nih.gov/pubmed/10219818 There may also be scatter than needs to be accounted for when planning treatment. https://www.ncbi.nlm.nih.gov/pubmed/21436751 That said, it is a good idea to try to minimize dose to the cochlear implant according to the limits per manufacturer's recommendations (call the manufacturer if the dose is not published). The device should be contoured out to determine the dose to the implant. Also note that the external device ...