{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T18:09:10Z","timestamp":1790618950679,"version":"4.1.0"},"reference-count":18,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Physics"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The presence of a cardiovascular implantable electronic device (CIED) is frequently viewed as a contraindication to proton therapy due to the creation of secondary neutrons that can potentially damage CIED electronics. As a result, photon therapy is typically recommended for patients with CIEDs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The study aims to provide a method for estimating neutron dose to a CIED by measuring equivalent neutron dose at varying distances from isocenter and field edge. This estimation can be used to guide clinical decisions by balancing the risk of neutron\u2010induced CIED damage against the therapeutic benefits of proton therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Standardized three\u2010dimensional measurement fields of varying dimensions were delivered using the IBA ProteusONE (Ion Beam Applications SA, Walloon Brabant, Belgium) pencil beam scanning proton therapy system, with each field delivering an RBE\u2010weighted dose of 2\u00a0Gy. Baseline measurement included one treatment field being delivered with a range shifter. BD\u2010PND detectors (Bubble Technology Industries, Chalk River, ON) were placed at a defined distances from the surface mark of beam isocenter and field edge to record neutron doses. Additionally, clinical treatment plans including two prostate\/pelvis plans, two head &amp; neck plans, two brain plans, and one breast plans were delivered, with detectors placed at positions corresponding to the location of a CIED.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      For fields without a range shifter, the measured neutron dose ranged from 0.11 \u00b5Sv\/2\u00a0Gy for the smallest field at 50\u00a0cm from isocenter to 11.0 \u00b5Sv\/2\u00a0Gy for the largest field size at 10\u00a0cm from isocenter for fields. The addition of a range shifter to the 10\u00a0\u00d7\u00a010\u00a0\u00d7\u00a010 cm\n                      <jats:sup>3<\/jats:sup>\n                      field increased the dose to 0.66 \u00b5Sv\/2\u00a0Gy at 50\u00a0cm to 14.2 \u00b5Sv\/2\u00a0Gy at 10\u00a0cm from isocenter. For clinical treatment plans, neutron doses ranging from 0.14 \u00b5Sv\/2\u00a0Gy to 9.5 \u00b5Sv \/2\u00a0Gy at 24\u201356\u00a0cm from isocenter.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These measurements provide a foundation for estimating neutron doses to CIEDs, enabling physicists and physicians to evaluate the feasibility of proton therapy for patients with CIEDs. The results support informed clinical decision\u2010making by quantifying the risk of neutron\u2010induced damage relative to the therapeutic benefits of proton therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mp.17987","type":"journal-article","created":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T04:55:28Z","timestamp":1752641728000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Estimates of cardiac implanted electronic device neutron dose for a pencil beam scanning proton therapy system"],"prefix":"10.1002","volume":"52","author":[{"given":"Karolyn M.","family":"Hopfensperger","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology University of Michigan Medical Center  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wangyao","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Kansas Medical Center  Kansas City Kansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seth H.","family":"Sheldon","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine University of Kansas Medical Center  Kansas City Kansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronny L.","family":"Rotondo","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Kansas Medical Center  Kansas City Kansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald C.","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Kansas Medical Center  Kansas City Kansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara St.","family":"James","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Huntsman Cancer Institute University of Utah  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuting","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Kansas Medical Center  Kansas City Kansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,15]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Particle Therapy Co\u2010Operative Group.Particle therapy facilities in clinical 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