{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:09:37Z","timestamp":1787069377205,"version":"build-2736575974"},"reference-count":35,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,5,15]],"date-time":"2024-05-15T00:00:00Z","timestamp":1715731200000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:sec>\n                    <jats:title>Key Clinical Message<\/jats:title>\n                    <jats:p>A patient presented with cardiogenic shock, requiring the implantation of a left ventricular assist device (LVAD), and acute myeloblastic leukemia. This necessitated total body irradiation (TBI) while balancing dose reduction to the LVAD components to avoid potential radiation damage. Here we outline our treatment approach and dose estimates to the LVAD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Abstract<\/jats:title>\n                    <jats:p>This case report discusses the delivery of TBI to a patient with an LVAD. This treatment required radiation\u2010dose determinations and consequential reductions for the heart, LVAD, and an external controller connected to the LVAD. The patient was treated using a traditional 16MV anterior posterior (AP)\/posterior anterior (PA) technique at a source\u2010to\u2010surface\u2010distance of 515\u2009cm for 400\u2009cGy in two fractions. A 3\u2009cm thick Cerrobend block was placed on the beam spoiler to reduce dose to the heart and LVAD to 150\u2009cGy. The external controller was placed in a 1\u2009cm thick acrylic box to reduce neutron dose and positioned as far from the treatment fields as achievable. In\u00a0vivo measurements were made using optically stimulated luminescence dosimeters (OSLDs) placed inside the box at distances of 2\u2009cm, 8.5\u2009cm, and 14\u2009cm from the field edge, and on the patient along the central axis and centered behind the LVAD block. Further ion chamber measurements were made using a solid water phantom to more accurately estimate the dose delivered to the LVAD. Neutron dose measurements were also conducted. The total estimated dose to the controller ranged from 135.3\u2009cGy to 91.5\u2009cGy. The LVAD block reduced the surface dose to the patient to 271.6\u2009cGy (68.1%). The block transmission factors of the 3\u2009cm Cerrobend block measured in the phantom were 45% at 1\u2009cm depth and decreased asymptotically to around 30% at 3\u2009cm depth. Applying these transmission factors to the in\u00a0vivo measurements yielded a dose of 120\u2009cGy to the implanted device. The neutron dose the LVAD region is estimated around 0.46\u2009cGy. Physical limitations of the controller made it impossible to completely avoid dose. Shielding is recommended. The block had limited dose reduction to the surface, due to secondary particles, but appropriately reduced the dose at 3\u2009cm and beyond. More research on LVADs dose limits would be beneficial.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ccr3.8868","type":"journal-article","created":{"date-parts":[[2024,5,15]],"date-time":"2024-05-15T23:44:25Z","timestamp":1715816665000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Case study with dosimetric analysis: Total body irradiation to a patient with a left ventricular assist device"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4306-5441","authenticated-orcid":false,"given":"Matthew","family":"Webster","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology University of Rochester Medical Center  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga M.","family":"Dona\u00a0Lemus","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Rochester Medical Center  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dandan","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Rochester Medical Center  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua N.","family":"Wancura","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Rochester Medical Center  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"Tanny","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Rochester Medical Center  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gukan","family":"Sakthivel","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Rochester Medical Center  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis","family":"Constine","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Rochester Medical Center  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,5,15]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw211"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.17415"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.adro.2021.100732"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.13838"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.597259"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAT.0b013e31823e5bcc"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2015.1787"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2015.12.003"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2021.01.2090"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1120\/jacmp.v9i4.2851"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaccao.2021.04.008"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.1666"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014-015-0378-8"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAT.0b013e3182468318"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.849113"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.3390\/curroncol28010089"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.phro.2019.08.001"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1120\/jacmp.v17i3.6128"},{"key":"e_1_2_12_20_1","article-title":"The physical aspects of total and half body photon irradiation","volume":"17","author":"Van Dyk J","year":"1986","journal-title":"AAPM Report"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1109\/TDMR.2005.858342"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.12462"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1602954"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1900486"},{"key":"e_1_2_12_25_1","first-page":"1","article-title":"Validating the percentage depth doses using two different phantom materials","volume":"5","author":"Diteko K","year":"2020","journal-title":"J Med Phys Appl Sci"},{"key":"e_1_2_12_26_1","unstructured":"UWADCL Scope of Accreditation.The University of Wisconsin Medical Radiation Research Center [Internet]. uwmrrc.wisc.edu. 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