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I have a young guy with ICM and medullary thyroid s/p thyroidectomy+ bilat neck dissection (lots of positive nodes) that I am treating to bilateral neck/upper mediastinum. He has a ICD in place for idiopathic cardiomyopathy for a few years. The ICD has never gone off. The manufacturer recommends no more than 5 Gy going to the pacemaker. Planning showed us just below 500; put a tld on at start of treatment and totaled up it would go to 5.19 Gy over the course of treatment. Do you guys have rec's in this case. We tried a bunch of different beam arrangements and this was the best we were getting. Device rep came out and interrogated today; is that necessary on a daily or weekly basis? Waiting to hear back from his EP. Thanks