What radiation dose is a risk for damaging function or active leads from a pacemaker?

This is a complex issue sometimes asked on our weekly OLA/ABR website. According to the updated 2019 AAPM TG-203 report published in Medical Physics by Miften et al., PMID 31571229, and the JACC review by Fradley et al., PMID 34604807, care for patients with CIEDs requires careful attention to indiv...

Lots of attention has been placed on the dose to the device itself (and to a lesser extent the leads of implanted devices such as pacemakers). The type and purpose of the device are very important and plays a role in what is permissible dose to the unit. For example, the risk to a pacemaker (PPM) on...

Zaremba et al., PMID 25601489. Beam energy >15MV is associated with higher risk of CIED complications.

Guidelines are found here. Fradley et al., PMID 34604807.

>5 Gy cumulative dose is considered high risk. Complete CIED interrogation at baseline and after RT is complete, at 1 month and 6 months af...

Ask yourself what the consequence of a malfunctioning electronic cardiac device is, death, and then proceed accordingly. Discuss directly with the electrophysiologist (EP cardiologist) exactly what the purpose of the device is, when the last time the device was interrogated, and depending on the loc...

A question was raised regarding changing the dose rate & its potential impact on the risk of dysfunction or malfunction of a PPM. Unfortunately, there is no good data on dose rate effects on the PPM lead or PPM leads. Given the low incidence of adverse events with PPMs, I would think that the abilit...