{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T14:01:55Z","timestamp":1789740115323,"version":"4.0.1"},"reference-count":17,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Magnetic resonance imaging (MRI) provides superior soft tissue contrast compared with CT and is essential for delineation of targets and organs at risk in brain radiotherapy. Because CT is traditionally required for dose calculation in radiation therapy, synthetic CT (sCT) generation from MRI has enabled the development of MR\u2010only workflows. Prior studies have primarily focused on dosimetric equivalence between CT\u2010 and sCT\u2010based treatment plans, with limited emphasis on practical implementation challenges encountered during clinical use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study aimed to share clinical experience implementing an MR\u2010only brain radiotherapy workflow, with a focus on practical challenges encountered.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Twenty\u2010eight patients underwent a dedicated MR simulation protocol for sCT generation in addition to standard\u2010of\u2010care planning CT simulation. MRI acquisition was performed using an immobilization mask with a dedicated head coil positioned over the mask. The sCT protocol consisted of four sequences: T1 VIBE Dixon, T2 SPACE, PETRA, and TOF\u2010MRA. Clinical treatment plans generated using the planning CT (pCT) for photon therapy were recalculated on the corresponding sCT datasets.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty\u2010eight patients were scanned, and 25 synthetic CT datasets were successfully generated. Nine sCT datasets required rigid re\u2010registration because of inter\u2010sequence patient motion. Findings were categorized into workflow\u2010related sCT challenges, including inter\u2010sequence motion, suboptimal coil placement, and external localization marker interference, and algorithm\u2010related imaging artifacts, including HU misclassification at tissue\/bone\/air interfaces and sCT degradation in post\u2010operative anatomy with surgical meshes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Clinical implementation of a brain MR\u2010only workflow identified two major categories of challenge: workflow\u2010related sCT perturbations and algorithm\u2010related imaging artifacts. This distinction has important implications for mitigation strategies. Case\u2010specific sCT review, structured eligibility screening, and prospective site commissioning are essential for safe clinical deployment. Practical commissioning and per\u2010patient QA checklists are provided as supplementary materials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70733","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T03:50:57Z","timestamp":1785815457000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Synthetic CT artifacts in MR\u2010only brain radiotherapy: Clinical implementation experience"],"prefix":"10.1002","volume":"27","author":[{"given":"Hyeri","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology The Ohio State University  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8554-5426","authenticated-orcid":false,"given":"Ahmet S.","family":"Ayan","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The Ohio State University  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sasha","family":"Beyer","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The Ohio State University  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dukagjin","family":"Blakaj","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The Ohio State University  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3222-7141","authenticated-orcid":false,"given":"Dominic","family":"DiCostanzo","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The Ohio State University  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Grecula","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The Ohio State University  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Palmer","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The Ohio State University  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raju","family":"Raval","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The Ohio State University  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raj","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The Ohio State University  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The Ohio State University  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Weldon","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The Ohio State University  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangyu","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Radiology The Ohio State University  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wesley","family":"Zoller","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The Ohio State University  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nilendu","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The Ohio State University  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/jjco\/hym050"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.598382"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0730\u2010725X(94)92206\u20103"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031\u20109155\/58\/23\/8419"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031\u20109155\/60\/2\/825"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.4914158"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.3109\/0284186X.2015.1062546"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2019.03.026"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.13139"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.phro.2025.100708"},{"key":"e_1_2_11_12_1","unstructured":"Encompass 15 channel head coil 3T | CQ Medical. 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