S1507
Interdisciplinary - Quality assurance and risk management
ESTRO 2026
Bergamo, Italy. 8 Medical Physics Unit, Asl Roma1, Roma, Italy. 9 Medical Physics Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy. 10 Medical Physics Unit, Policlinico di Monza, Monza, Italy. 11 Medical Physics Unit, ASUFC Udine, Udine, Italy. 12 UOC Radioterapia, Ospedale del Mare ASL Napoli 1 Centro, Napoli, Italy. 13 Medical Physics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy. 14 UOSD di Fisica Sanitaria, ASL2 Lanciano-Vasto-Chieti, Chieti, Italy
techniques (figure 2). Based on these findings, we developed two logistic regression models. In the no contour and/or dose fractionation modification request model (AUC=0.61), stereotactic radiotherapy were significantly associated with no modification requests, non-re-RT, IMRT and 3DCRT showed borderline associations with no contour and/or dose fractionation modification requests (p < 0.1 for both). In the dose distribution modification request model (AUC=0.76), IMRT was significantly associated with a higher likelihood of no modification requests (p < 0.05), and non-re-RT showed a borderline association (p < 0.1).
Purpose/Objective: Current radiotherapy guidelines for Cardiac
Implantable Electronic Devices (CIEDs) (LVADs, PMs, and ICDs) are largely based on clinical management strategies and retrospective reports. In this work we present a systematic review on CIEDs from a Medical Physics perspective to provide a critical, quantitative analysis of the technical evidence required for developing robust safety action plans. Material/Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic search (Jan 2014–Dec 2024) across five major databases. Sixteen physicists from the Associazione Italiana di Fisica Medica (AIFM) Working Group (WG) performed a double-review and standardized data extraction, focusing on physics- specific variables for the irradiation of the devices. Data were grouped into four topics: photon/electron RT, hadron therapy, modeling RT effects (TPS/MC), and imaging. The Malfunction Rate (MR)—defined as the percentage of devices with a clinically relevant malfunction (CR)—was calculated. Differences in MR across physical variables were assessed using the z- test (α=0.05). The physical variables analyzed included radiation type (photons, electrons, protons, ions), irradiation condition (in-field/out-of-field), beam energy, dose rate for FFF beams, and total device dose. Results: Of the 56 selected articles, 44 were co-authored by physicists. The analysis considered 1,743 real devices (961 PMs, 719 ICDs, 18 LVADs) and 13 virtual devices. The overall MR was 12.6% (214 affected devices out of 1,680 PMs/ICDs analyzed). PMs (9.3%) had a significantly lower MR than ICDs (17.1%). LVAD data was insufficient for analysis. Radiation type strongly influenced risk: Photon beams (12.2% MR) carried a lower risk than Hadron beams (18.0% MR). All hadron failures were CR events. For photons, risk increased substantially with dose (≥5Gy vs. < 5 Gy) and position (Primary beam: 24.2% vs. Scatter: 6.0%). Lower 6 MV energy beams significantly reduced MR compared to higher energies. Additionally, for 6 MV, WFF beams yielded better outcomes than FFF beams.
Figure 2: Percentage of (a) contours and/or dose fractionations and (b) dose distributions with modifications requests. Conclusion: This secondary analysis of the PRIORITY trial demonstrates that predictive modeling can guide a risk-adapted peer-review approach in radiation oncology. While the primary endpoint confirmed the benefit of two-step peer-review, this analysis identified low-risk subgroups such as non-re-RT 3DCRT, non-re- RT IMRT or non-re-RT stereotactic treatments, where one or both peer-review steps could be safely omitted. Keywords: peer-review Systematic review of physical and dosimetric criteria for managing CIEDs in radiotherapy: a medical physicist’s perspective Rita Alaimo 1 , Tiziana Malatesta 2 , Agnese Barbareschi 3 , Emilio Mezzenga 4 , Maria Grazia Brambilla 5 , Anna Delana 6 , Stefano Andreoli 7 , Rita Consorti 8 , Stefano Ren Kaiser 9 , Marco Mapelli 10 , Eugenia Moretti 11 , Maria Mormile 12 , Giulia Rambaldi Guidasci 2 , Mara Severgnini 9 , Lidia Strigari 13 , Maria Daniela Falco 14 1 Medical Physics Unit, Ospedale di Perugia, Perugia, Italy. 2 Medical Physics Unit, Centro di Eccellenza Oncologia Radioterapica, Medica e Diagnostica per Immagini, Ospedale Isola Tiberina - Gemelli Isola, Roma, Italy. 3 Medical Physics Unit, Ospedale S. Chiara, Perugia, Italy. 4 Medical Physics Unit, IRCCS Istituto Digital Poster Highlight 1357 Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy. 5 Medical Physics Unit, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy. 6 Medical Physics Unit, Ospedale S. Chiara, Trento, Italy. 7 Medical Physics Unit, ASST Papa Giovanni XXIII,
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