Implementing Cardiac Implantable Electronic Device Workflow Using the American Association of Physicists in Medicine (AAPM) Task Group 203 Guidelines.

PURPOSE/OBJECTIVE(S) Updated guidelines for the management of radiation oncology patients with Cardiac Implantable Electronic Devices (CIED) were released in the last quarter of 2019. Within a multi-site academic radiation oncology practice, a committee was formed to include physicians, nurses, therapists, physicists and dosimetrists to review updated guidelines and refine the current workflow in order to enhance patient safety. MATERIALS/METHODS The multidisciplinary team was created to review the AAPM Task Group 203 (TG-203) guidelines and develop a new standard operating procedure (SOP) for the management of patients with a CIED undergoing radiation therapy treatment. The team recognized the importance of nursing in this process and determined that the process to manage this patient population should be nurse driven. A cardiac device carepath and cardiac device checklist were created within the electronic health record (ARIA). The SOP, care path and checklist were reviewed and approved by the multidisciplinary team to include cardiology. RESULTS Optimized workflow for CIED patients includes identification of these patients at the time of consultation by nursing. The radiation oncology nurse then launches the ARIA care path and encounter to initiate CIED workflow which facilitates communication and care coordination. An alert is placed in the patient's ARIA record and a copy of the CIED card is scanned into ARIA. A consult is then placed with cardiology for recommendations regarding risk level and interrogations schedule. Simulation therapist measures the proximity of the treatment field to the device and documents in ARIA. If CIED is within 3 CM of the field or 5% isodose line the dosimetrist will contour the CIED as a structure and determine DVH/point dose. Physics performs in vivo measurements per TG203 guidelines and documents in ARIA record. Patients are followed throughout treatment to verify interrogation time points are completed. All documentation of this process is performed using ARIA carepaths and checklists as outlined above. CONCLUSION By implementing the AAPM TG-203 guidelines, this multidisciplinary team has been able to create a workflow to enhance patient safety. It has standardized the CIED management across our six campuses and ensures that all key stakeholders are involved in the workflow. Use of ARIA based documentation creates a stream-lined, transparent process that could be easily duplicated within other radiation oncology clinics.