[Intl_DxMedPhys] insulin pumps and CT

Tue Mar 4 15:38:45 EST 2025

Does this occur at diagnostic radiation levels? If so, how is it possible for our test equipment to operate? When I worked at Victoreen and Keithley, there were numerous products that we designed with electrometers (consisting of an op-amp with capacitor feedback) sitting right in the X-ray beam. If the feedback capacitor turned into a low Z resistor, I don’t understand how they could have been successful in integrating charge.

Robert J. Kobistek, MS, FACR, DABR, MRSE(MRSC™)
Medical Physicist
RJK Medical Physics, Inc.
440-463-7879

PLEASE NOTE MY NEW EMAIL ADDRESS Bob at RJKMedPhys.com<mailto:Bob at RJKMedPhys.com>

From: Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces at lists.osu.edu> On Behalf Of andrew.d.maidment--- via Intl_dxmedphys_wd_osu_list
Sent: Tuesday, March 4, 2025 12:07 PM
To: Winter David S Lt Col USAF MDG <david.s.winter6.mil at health.mil>
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Subject: Re: [Intl_DxMedPhys] insulin pumps and CT

Virtually anything will turn into a conductor when irradiated. I’ve tried this on many materials. Xray a capacitor and it will discharge and act like a very low impedance resistor. This effect ends as soon as the irradiation ends. So most electrical
Virtually anything will turn into a conductor when irradiated.  I’ve tried this on many materials.  Xray a capacitor and it will discharge and act like a very low impedance resistor.  This effect ends as soon as the irradiation ends.  So most electrical devices if powered down should be reactively unaffected by irradiation. Of course semiconductors will be damaged to variable degree depending on the design rules, construction/composition, and feature size. But it is possible to make rad hard semiconductors.
Andrew
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On Mar 4, 2025, at 9:36 AM, Winter, David S (Scott) Lt Col USAF 81 MDG (USA) via Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>> wrote:

All of this makes me wonder if manufacturers take precautions to ensure these devices are not scanned by industrial strength x-ray scanners in transit… (e. g. customs inspections). Scott Winter From: Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces@ lists. osu. edu>
All of this makes me wonder if manufacturers take precautions to ensure these devices are not scanned by industrial strength x-ray scanners in transit… (e.g. customs inspections).

Scott Winter

From: Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list-bounces at lists.osu.edu>> On Behalf Of Steiner, Joseph [BSD] via Intl_dxmedphys_wd_osu_list
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Subject: [Non-DoD Source] Re: [Intl_DxMedPhys] insulin pumps and CT

Has anyone had to deal with these devices in the context of nuclear medicine? A few years ago, I was at a site where we implemented these policies at the behest of our quality department for PET/CT (due to CT, not PET, we specifically asked
Has anyone had to deal with these devices in the context of nuclear medicine? A few years ago, I was at a site where we implemented these policies at the behest of our quality department for PET/CT (due to CT, not PET, we specifically asked about this). At the time we did not have to do anything for general NM or more significantly RPT.

The paper linked below it states the following for PET, seems most vendors want it removed for the procedure and you can put it or a replacement back on when the procedure is done… but the patient is still radioactive.

<image003.png>

I have never succeeded in finding a threshold dose rate, a cumulative dose, or a combination of both that would result in these devices not working in the context of x-ray, CT, fluoro, radiology, NM, PET, RPT, etc.

I can understand the vendor trying to save themselves from liability if a device fails after a radiology procedure. But having patients remove, turn off, replace, etc. these devices just because the vendor says “radiation may cause these devices to malfunction” just to prevent liability is doing our patients a huge disservice.

Thanks
Joe

From: Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces+joseph.steiner=bsd.uchicago.edu at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list-bounces+joseph.steiner=bsd.uchicago.edu at lists.osu.edu>> On Behalf Of McCann, Aaron via Intl_dxmedphys_wd_osu_list
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Subject: [EXTERNAL] Re: [Intl_DxMedPhys] insulin pumps and CT

Hi all, Sites *not* employing an all-or-nothing policy should be aware that this is still a dynamic field and that further testing of these devices may result in changes to their formal safety status. For example, some (not all) FreeStyle Libre

Hi all, Sites *not* employing an all-or-nothing policy should be aware that this is still a dynamic field and that further testing of these devices may result in changes to their formal safety status. For example, some (not all) FreeStyle Libre
Hi all,

Sites *not* employing an all-or-nothing policy should be aware that this is still a dynamic field and that further testing of these devices may result in changes to their formal safety status. For example, some (not all) FreeStyle Libre device models have recently received FDA clearance as MR Conditional (and as safe to be worn during CT, x-ray and diathermy procedures), rendering the published table at the start of this thread out of date:

https://urldefense.com/v3/__https://www.medscape.com/viewarticle/newer-abbott-libre-cgm-sensor-use-now-okay-during-imaging-2024a1000k2f__;!!KGKeukY!xxglRBGCMmQ4zCvUWbOFrcPiHkERVFOqrnlcbLBpcsR-ZVVjwdZWso9sHXAABVZayJ4giqqFbR-Y_q7oZy5HSefGVWLHC0YxGlmXIg$ <https://urldefense.com/v3/__https:/www.medscape.com/viewarticle/newer-abbott-libre-cgm-sensor-use-now-okay-during-imaging-2024a1000k2f__;!!KGKeukY!1yQF-zi8pBgrZt7dRpfQlNwTOuUuyWkqZ7TVrQXQsopDp4yV6K4ld7Dgwx5Rf3vymWx8A8xw2ssfb4aVWHUi_xoOx656tZIZgXKO2cLIuNMqEfVRVrWz1K8$>

One other consideration: I am aware of at least one report where a patient was informed that their glucose monitor should be removed prior to MRI – they did so themselves a few hours before their examination, and subsequently suffered a hypoglycaemic episode during the scan. These devices are critical for some patients in managing their own conditions, and the duration without monitoring should be kept as short as possible. Having an advance plan in place for removal and replacement that involves the patient is important.

Kind regards,
Aaron
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From: Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces+aaron.mccann=belfasttrust.hscni.net at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list-bounces+aaron.mccann=belfasttrust.hscni.net at lists.osu.edu>> On Behalf Of Szczykutowicz, Timothy P via Intl_dxmedphys_wd_osu_list
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Subject: Re: [Intl_DxMedPhys] insulin pumps and CT

The borders of the state are the borders of the university (badgers will get this reference) Attached is our current all or nothing policy. Thanks to all who have sent me their policies and links!!! I also just pinged my rad onc friends that
The borders of the state are the borders of the university (badgers will get this reference)

Attached is our current all or nothing policy.

Thanks to all who have sent me their policies and links!!!

I also just pinged my rad onc friends that live in the basement here. They brought up a good point…. What are you going to do for 25 fractions!?

-stick

Timothy P. Szczykutowicz, Ph.D., DABR
Associate Professor
Departments of Radiology, Medical Physics and BME
University of Wisconsin Madison
Cell# 1-716-560-7751
Office# 1-608-263-5729
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From: Josh M Wilson <joshua.wilson at duke.edu<mailto:joshua.wilson at duke.edu>>
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Subject: Re: insulin pumps and CT

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Deja vu; attached from the old listserv. As far as I can tell, no one publicly shared a policy to the last request. YMMV.

Best,
Josh M. Wilson, PhD

Radiation Physicist, Clinical Imaging Physics Group
Duke University Health System

Director, Duke Imaging Physics Residency Program
Assistant Professor, Department of Radiology
Duke University School of Medicine
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Subject: Re: [Intl_DxMedPhys] insulin pumps and CT

Hey Tim,

This is an important topic, and one that has substantial cost liability for patients who, for some units, must replace those devices, and, as you allude to, substantial liability for institutions that do anything other than what the device manufacturers state.

Perhaps this is a topic to bring to the AAPM MPI (Medical Physics Institute) for investigation as a potential project? Jatinder Palta is the director of this new endeavor and might be interested in hearing about this need.

Kind regards,

Kevin

<image004.png>

Kevin Wunderle, PhD, FAAPM, FACR
Professor, Department of Radiology

Diagnostic Medical Physicist
395 W. 12th Avenue,

Floor 4, Room 424

Columbus, OH, 43210
216-245-5513 Mobile
kevin.wunderle at osumc.edu<mailto:kevin.wunderle at osumc.edu>

From: Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces+kevin.wunderle=osumc.edu at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list-bounces+kevin.wunderle=osumc.edu at lists.osu.edu>> On Behalf Of Szczykutowicz, Timothy P via Intl_dxmedphys_wd_osu_list
Sent: Monday, March 3, 2025 4:24 PM
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Subject: [Intl_DxMedPhys] insulin pumps and CT

Anyone have a policy for insulin pumps and sensors other than “taken them off” for CT they are willing to share? huge risk if they malfunction…possible death, so I get why folks defer to the vendor policies which don’t

Anyone have a policy for insulin pumps and sensors other than “taken them off” for CT they are willing to share?

huge risk if they malfunction…possible death, so I get why folks defer to the vendor policies which don’t appear to be actually tested inside a scanner.

I found this paper, link below. But it basically says listen to the vendors. It seems in practice, this would be complicated if we have to have  a workflow where each device is looked up.

https://urldefense.com/v3/__https://link.springer.com/article/10.1007/s11892-021-01375-7__;!!KGKeukY!xxglRBGCMmQ4zCvUWbOFrcPiHkERVFOqrnlcbLBpcsR-ZVVjwdZWso9sHXAABVZayJ4giqqFbR-Y_q7oZy5HSefGVWLHC0aqQ3XPmg$ <https://urldefense.com/v3/__https:/link.springer.com/article/10.1007/s11892-021-01375-7__;!!KGKeukY!2X8iwvcZaThROZKzTShLM48XXAAcboXdv6Nd6eTUed_wyUTOhUxUGhsoBXCoSXWbfJXR7CxWoS34HSLrfILeEy0e1iO_WRko7ct0-yQ3BcMzZ9HaWQ$>

<image005.jpg>

Timothy P. Szczykutowicz, Ph.D., DABR
Associate Professor
Departments of Radiology, Medical Physics and BME
University of Wisconsin Madison
Cell# 1-716-560-7751
Office# 1-608-263-5729
he/him/his

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