Zecchin Massimo, Morea Gaetano, Severgnini Mara, Sergi Elisabetta, Baratto Roldan Anna, Bianco Elisabetta, Magnani Silvia, De Luca Antonio, Zorzin Fantasia Anna, Salvatore Luca, Milan Vittorino, Giannini Gianrossano, Sinagra Gianfranco
Cardiovascular Department, University and Hospital, Trieste, Italy
Cardiovascular Department, University and Hospital, Trieste, Italy.
Europace. 2016 Feb;18(2):288-93. doi: 10.1093/europace/euv250. Epub 2015 Sep 1.
Malfunctions of cardiac implantable electronical devices (CIED) have been described after high-energy radiation therapy even in the absence of direct exposure to ionizing radiation, due to diffusion of neutrons (n) causing soft errors in inner circuits. The purpose of the study was to analyse the effect of scattered radiation on different types and models of CIED and the possible sources of malfunctions.
Fifty-nine explanted CIED were placed on an anthropomorphous phantom of tissue-equivalent material, and a high-energy photon (15 MV) radiotherapy course (total dose = 70 Gy) for prostate treatment was performed. All devices were interrogated before and after radiation. Radiation dose, the electromagnetic field, and neutron fluence at the CIED site were measured. Thirty-four pacemakers (PM) and 25 implantable cardioverter-defibrillators (ICD) were analysed. No malfunctions were detected before radiation. After radiation a software malfunction was evident in 13 (52%) ICD and 6 (18%) PM; no significant electromagnetic field or photon radiations were detected in the thoracic region. Neutron capture was demonstrated by the presence of the (198)Au((197)Au + n) or (192)Ir((191)Ir + n) isotope activation; it was significantly greater in ICD than in PM and non-significantly greater in damaged devices. A greater effect in St Jude PM (2/2 damaged), Boston (9/11), and St Jude ICD (3/6) and in older ICD models was observed; the year of production was not relevant in PM.
High-energy radiation can cause different malfunctions on CIED, particularly ICD, even without direct exposure to ionizing radiation due to scattered radiation of neutrons produced by the linear accelerator.
即使在未直接暴露于电离辐射的情况下，高能放射治疗后也有心脏植入式电子设备（CIED）故障的相关报道，这是由于中子扩散导致内部电路出现软错误。本研究的目的是分析散射辐射对不同类型和型号CIED的影响以及可能的故障源。
将59个取出的CIED放置在组织等效材料的人体模型上，进行用于前列腺治疗的高能光子（15 MV）放射治疗疗程（总剂量 = 70 Gy）。在辐射前后对所有设备进行询问。测量CIED部位的辐射剂量、电磁场和中子注量。分析了34个起搏器（PM）和25个植入式心律转复除颤器（ICD）。辐射前未检测到故障。辐射后，13个（52%）ICD和6个（18%）PM出现软件故障；在胸部区域未检测到明显的电磁场或光子辐射。通过（198）Au（（197）Au + n）或（192）Ir（（191）Ir + n）同位素活化证明了中子俘获；ICD中的中子俘获明显高于PM，受损设备中的中子俘获略高。在圣犹达PM（2/2受损）、波士顿（9/11）、圣犹达ICD（3/6）以及较旧的ICD型号中观察到更大的影响；生产年份与PM故障无关。
即使没有直接暴露于线性加速器产生的中子散射辐射引起的电离辐射，高能辐射也会导致CIED出现不同故障，尤其是ICD。
