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This systematic review adopts a medical physics perspectiv\n                      <jats:bold>e<\/jats:bold>\n                      to provide a critical, quantitative analysis of the technical evidence required for developing robust safety action plans.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>Following the Preferred Reporting Items for Systematic Reviews and Meta\u2010Analyses (PRISMA) guidelines, a systematic search was conducted (January 2014\u2013December 2024) across five major databases. Sixteen physicists from the Associazione Italiana di Fisica Medica e Sanitaria (AIFM) Working Group (WG) performed a double\u2010review and standardized data extraction, focusing on physics\u2010specific variables for the irradiation of Left Ventricular Assist Devices (LVADs), Pacemakers (PMs), and Implantable Cardioverter\u2010Defibrillator (ICD) devices. Data were grouped into five topics: photon\/electron RT, hadron therapy, modeling RT effects (Treatment Planning System [TPS]\/Monte Carlo [MC]), imaging, and specific considerations regarding Magnetic Resonance Imaging Linac (MRI\u2010Linac) systems. The Malfunction Rate (MR)\u2014the percentage of devices with a clinically relevant malfunction\u2014was calculated, and a Z\u2010test was carried out to highlight safer irradiation conditions. Additionally, a narrative synthesis was performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 60 selected articles, 47 were co\u2010authored by physicists. The studies considered a total of 1769 real devices, while 13 studies reported on virtual devices (i.e., simulations, electronics, or measurements only). Reported irradiation beams included photons (encompassing Intra\u2010Operative RadioTherapy [IORT], Total Body Irradiation [TBI], and Flattening Filter Free [FFF] beams), electrons, protons, and carbon ions. Thirty\u2010seven manuscripts investigated CIED malfunctions, yielding an overall MR of 12.6%. The MR was significantly lower for devices irradiated under scatter conditions and when non\u2010neutron\u2010producing beams were used. Information on the entire RT process (imaging, dose calculation, planning, and irradiation) was analyzed, and a flowchart was developed to guide medical physicists in their daily clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The review concludes that the medical physicist's role is non\u2010negotiable in developing and implementing advanced planning and dosimetry strategies to prevent CIED malfunction and ensure patient safety.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70740","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T05:48:01Z","timestamp":1786945681000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Systematic review of physical and dosimetric criteria for managing CIEDs in radiotherapy: A medical physicist's perspective"],"prefix":"10.1002","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8235-6921","authenticated-orcid":false,"given":"Tiziana","family":"Malatesta","sequence":"first","affiliation":[{"name":"Medical Physics Unit, Centro di Eccellenza Oncologia Radioterapica, Medica e Diagnostica per Immagini, Ospedale Isola Tiberina \u2013 Gemelli Isola  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2150-6978","authenticated-orcid":false,"given":"Agnese","family":"Barbareschi","sequence":"additional","affiliation":[{"name":"Medical Physics Unit Ospedale S. 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