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Cardiac implantable electronic device (CIED) malfunctions can be induced by secondary neutron dose from spot-scanning proton therapy. A recent in-vitro study investigating secondary neutron dose to CIEDs up to 7 mSv per fraction found that exposure of secondary neutrons in this range was clinically manageable. This study presents decision algorithms proposed by a national expert group for selection of patients with breast and head &amp; neck (H&amp;N) cancer with CIEDs adjacent to target for proton therapy based on the 7 mSv threshold.

Spot-scanning proton therapy for targets with adjacent cardiac implantable electronic devices – Strategies for breast and head & neck cancer