{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:05:50Z","timestamp":1787061950063,"version":"build-2736575974"},"reference-count":39,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,4,11]],"date-time":"2020-04-11T00:00:00Z","timestamp":1586563200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study focused on determining risks from stereotactic radiotherapy using flattening filter\u2010free (FFF) beams for patients with cardiac implantable electronic device (CIEDs). Two strategies were employed: a) a retrospective analysis of patients with CIEDs who underwent stereotactic radiosurgery (SRS)\/SBRT at the Peter MacCallum Cancer Centre between 2014 and 2018 and b) an experimental study on the impact of FFF beams on CIEDs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective review was performed. Subsequently, a phantom study was performed using 30 fully functional explanted CIEDs from two different manufacturers. Irradiation was carried out in a slab phantom with 6\u2010MV and 10\u2010MV FFF beams. First, a repetition\u2010rate test (RRT) with a range of beam pulse frequencies was conducted. Then, multifraction SBRT (48\u00a0Gy\/4\u00a0Fx) and single\u2010fraction SBRT (28\u00a0Gy\/1\u00a0Fx) treatment plans were used for lung tumors delivered to the phantom.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Between 2014 and 2018, 13 cases were treated with an FFF beam (6\u00a0MV, 1400\u00a0MU\/min or 10\u00a0MV, 2400\u00a0MU\/min), and 15 cases were treated with a flattening filter (FF) beam (6\u00a0MV, 600\u00a0MU\/min). All the devices were positioned outside the treatment field at a distance of more than 5\u00a0cm, except for one case, and no failures were reported due to SBRT\/SRS. In the phantom rep\u2010rate tests, inappropriate sensing occurred, starting at a rep\u2010rate of 1200\u00a0MU\/min. Cardiac implantable electronic device anomalies during and after delivering VMAT\u2010SBRT with a 10\u2010MV FFF beam were observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The study showed that caution should be paid to managing CIED patients when they undergo SBRT using FFF beams, as it is recommended by AAPM TG\u2010203. Correspondingly, it was found that for FFF beams although there is small risk from dose\u2010rate effects, delivering high dose of radiation with beam energy greater than 6 MV and high\u2010dose rate to CIEDs positioned in close vicinity of the PTV may present issues.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.12873","type":"journal-article","created":{"date-parts":[[2020,4,11]],"date-time":"2020-04-11T05:44:09Z","timestamp":1586583849000},"page":"121-131","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["The effect of stereotactic body radiotherapy (SBRT) using flattening filter\u2010free beams on cardiac implantable electronic devices (CIEDs) in clinical situations"],"prefix":"10.1002","volume":"21","author":[{"given":"Hossein","family":"Aslian","sequence":"first","affiliation":[{"name":"Department of Physics University of Trieste Trieste 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