{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:04:52Z","timestamp":1790139892389,"version":"4.0.1"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T00:00:00Z","timestamp":1753056000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T00:00:00Z","timestamp":1753056000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001801","name":"University of Western Australia","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001801","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Phys Eng Sci Med"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>This study evaluates the clinical feasibility of spine stereotactic body radiotherapy (SBRT) in the presence of titanium and carbon fibre-reinforced polyetheretherketone (CFR-PEEK) spinal implants using custom 3D-printed phantoms. The investigation focuses on the dosimetric accuracy, imaging challenges, and achievable localisation precision. Customised 3D-printed phantoms incorporating titanium and CFR-PEEK implants were computed tomography (CT) scanned, with and without metal artefact reduction (MAR) algorithms. Localisation accuracy was tested using Elekta XVI CBCT and Brainlab ExacTrac Dynamic. The dosimetric accuracy of the Monaco treatment planning system (TPS) was assessed under simple geometric conditions and for clinically realistic VMAT plans. Patient-specific quality assurance and phantom-based measurements using ionization chambers and radiochromic film were performed to evaluate delivered dose accuracy. Both Image Guided Radiotherapy (IGRT) systems achieved sub-millimetre localisation accuracy, with maximum deviations of 0.3\u00a0mm observed for titanium implants. The Monaco treatment planning system (TPS) demonstrated accurate dose modelling, with deviations\u2009&lt;\u20091% for CFR-PEEK and &lt;\u20092% for titanium implants in simple homogeneous arrangements. In complex VMAT plan deliveries, dosimetric measurements showed stronger agreement with TPS predictions for CFR-PEEK implants, with deviations\u2009&lt;\u20093%. Titanium-based plans exhibited greater deviations, with localised dose discrepancies exceeding clinical tolerances of 5%. The application of MAR algorithms reduced these discrepancies to &lt;\u20095%, ensuring clinically acceptable dosimetric accuracy. CFR-PEEK implants enhance clinical workflows due to reduced imaging artefacts and smoother dose distributions, making MAR corrections unnecessary. For titanium implants, MAR is essential to achieve clinically acceptable dosimetric accuracy, highlighting the robustness of CFR-PEEK for spine SBRT.<\/jats:p>","DOI":"10.1007\/s13246-025-01587-1","type":"journal-article","created":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T09:22:18Z","timestamp":1753089738000},"page":"1325-1336","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Advantages of carbon fibre-reinforced polyetheretherketone over titanium implants in spine SBRT: a phantom evaluation"],"prefix":"10.1007","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3318-9703","authenticated-orcid":false,"given":"Simon K.","family":"Goodall","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2073-3044","authenticated-orcid":false,"given":"Katherine","family":"Tonkin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Rampant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8306-7742","authenticated-orcid":false,"given":"Pejman","family":"Rowshan Farzad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6875-0719","authenticated-orcid":false,"given":"Martin","family":"Ebert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,21]]},"reference":[{"key":"1587_CR1","doi-asserted-by":"publisher","first-page":"109966","DOI":"10.1016\/j.radonc.2023.109966","volume":"190","author":"M Guckenberger","year":"2024","unstructured":"Guckenberger M et al (2024) ESTRO clinical practice guideline: stereotactic body radiotherapy for spine metastases. Radiother Oncol 190:109966","journal-title":"Radiother Oncol"},{"key":"1587_CR2","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.wneu.2023.01.090","volume":"173","author":"RJ Perez-Roman","year":"2023","unstructured":"Perez-Roman RJ et al (2023) The use of carbon fiber-reinforced instrumentation in patients with spinal oncologic tumors: a systematic review of literature and future directions. World Neurosurg 173:13\u201322","journal-title":"World Neurosurg"},{"key":"1587_CR3","first-page":"377","volume":"43","author":"K Byrnes","year":"2020","unstructured":"Byrnes K, Kairn T (2020) Comparison and verification of multiple radiotherapy TPS in modelling radiation transport through a metal spine implant in a water equivalent phantom. Phys Eng Sci Med 43:377\u2013378","journal-title":"Phys Eng Sci Med"},{"issue":"3","key":"1587_CR4","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1120\/jacmp.v17i3.5536","volume":"17","author":"ZKJ Cheng","year":"2016","unstructured":"Cheng ZKJ et al (2016) On the accuracy of dose prediction near metal fixation devices for spine SBRT. J Appl Clin Med Phys 17(3):475\u2013485","journal-title":"J Appl Clin Med Phys"},{"issue":"23","key":"1587_CR5","doi-asserted-by":"publisher","first-page":"7181","DOI":"10.1088\/0031-9155\/59\/23\/7181","volume":"59","author":"I Dietlicher","year":"2014","unstructured":"Dietlicher I et al (2014) The effect of surgical titanium rods on proton therapy delivered for cervical bone tumors: experimental validation using an anthropomorphic phantom. Phys Med Biol 59(23):7181\u20137194","journal-title":"Phys Med Biol"},{"issue":"2","key":"1587_CR6","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.prro.2015.10.012","volume":"6","author":"MP Grams","year":"2016","unstructured":"Grams MP et al (2016) Cadaveric verification of the eclipse AAA algorithm for spine SBRT treatments with titanium hardware. Pract Radiat Oncol 6(2):131\u2013141","journal-title":"Pract Radiat Oncol"},{"issue":"1","key":"1587_CR7","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1186\/s13014-022-02058-7","volume":"17","author":"D Henzen","year":"2022","unstructured":"Henzen D et al (2022) Feasibility of postoperative spine stereotactic body radiation therapy in proximity of carbon and titanium hybrid implants using a robotic radiotherapy device. Radiat Oncol 17(1):94","journal-title":"Radiat Oncol"},{"key":"1587_CR8","doi-asserted-by":"crossref","unstructured":"Hoang AT, Jong WL, Ung NM (2019) Addressing the dose perturbation of metallic implant in spinal Stereotactic Body Radiotherapy (SBRT). In: 18th Asia-Oceania congress of medical physics (AOCMP) & 16th South-East Asia congress of medical physics (SEACOMP)","DOI":"10.1088\/1742-6596\/1248\/1\/012040"},{"issue":"10","key":"1587_CR9","doi-asserted-by":"publisher","first-page":"e14070","DOI":"10.1002\/acm2.14070","volume":"24","author":"CW Liu","year":"2023","unstructured":"Liu CW et al (2023) The dosimetric impact of titanium implants in spinal SBRT using four commercial treatment planning algorithms. J Appl Clin Med Phys 24(10):e14070","journal-title":"J Appl Clin Med Phys"},{"key":"1587_CR10","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.ejmp.2017.11.008","volume":"44","author":"E Mastella","year":"2017","unstructured":"Mastella E et al (2017) Dosimetric characterization of carbon fiber stabilization devices for post-operative particle therapy. Phys Med 44:18\u201325","journal-title":"Phys Med"},{"issue":"8","key":"1587_CR11","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1002\/acm2.12905","volume":"21","author":"BS M\u00fcller","year":"2020","unstructured":"M\u00fcller BS et al (2020) The dosimetric impact of stabilizing spinal implants in radiotherapy treatment planning with protons and photons: standard titanium alloy vs. radiolucent carbon-fiber-reinforced PEEK systems. J Appl Clin Med Phys 21(8):6\u201314","journal-title":"J Appl Clin Med Phys"},{"issue":"2","key":"1587_CR12","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1002\/acm2.12046","volume":"18","author":"A Nevelsky","year":"2020","unstructured":"Nevelsky A et al (2017) Perturbation effects of the carbon fiber-PEEK screws on radiotherapy dose distribution. J Appl Clin Med Phys 18(2):62\u201368","journal-title":"J Appl Clin Med Phys"},{"issue":"8","key":"1587_CR13","doi-asserted-by":"publisher","first-page":"4586","DOI":"10.1002\/mp.15070","volume":"48","author":"SK Goodall","year":"2021","unstructured":"Goodall SK et al (2021) Investigation of the effects of spinal surgical implants on radiotherapy dosimetry: a study of 3D printed phantoms. Med Phys 48(8):4586\u20134597","journal-title":"Med Phys"},{"key":"1587_CR14","doi-asserted-by":"publisher","first-page":"100449","DOI":"10.1016\/j.phro.2023.100449","volume":"26","author":"D Ignatius","year":"2023","unstructured":"Ignatius D et al (2023) Radiotherapy planning of spine and pelvis using single-energy metal artifact reduction corrected computed tomography sets. Phys Imaging Radiat Oncol 26:100449","journal-title":"Phys Imaging Radiat Oncol"},{"issue":"2","key":"1587_CR15","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1007\/s13246-017-0543-5","volume":"40","author":"C Guilfoile","year":"2017","unstructured":"Guilfoile C, Rampant P, House M (2017) The impact of smart metal artefact reduction algorithm for use in radiotherapy treatment planning. Australas Phys Eng Sci Med 40(2):385\u2013394","journal-title":"Australas Phys Eng Sci Med"},{"issue":"5","key":"1587_CR16","doi-asserted-by":"publisher","first-page":"e597","DOI":"10.1016\/j.ijrobp.2012.03.009","volume":"83","author":"BWMD Cox","year":"2012","unstructured":"Cox BWMD et al (2012) International spine radiosurgery consortium consensus guidelines for target volume definition in spinal stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 83(5):e597\u2013e605","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"3","key":"1587_CR17","doi-asserted-by":"publisher","first-page":"e52","DOI":"10.1002\/mp.13995","volume":"47","author":"SF Kry","year":"2020","unstructured":"Kry SF et al (2020) AAPM task group 329: reference dose specification for dose calculations: Dose-to-water or dose-to-muscle? Med Phys 47(3):e52\u2013e64","journal-title":"Med Phys"},{"key":"1587_CR18","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1016\/j.radonc.2021.03.006","volume":"159","author":"SF Kry","year":"2021","unstructured":"Kry SF et al (2021) Report dose-to-medium in clinical trials where available; a consensus from the global harmonisation group to maximize consistency. Radiother Oncol 159:106\u2013111","journal-title":"Radiother Oncol"},{"key":"1587_CR19","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1016\/j.ejmp.2021.03.011","volume":"84","author":"M Shaw","year":"2021","unstructured":"Shaw M et al (2021) Measuring the dose in bone for spine stereotactic body radiotherapy. Phys Med 84:265\u2013273","journal-title":"Phys Med"},{"key":"1587_CR20","first-page":"100716","volume":"45","author":"L Burgess","year":"2024","unstructured":"Burgess L et al (2024) Practice and principles of stereotactic body radiation therapy for spine and non-spine bone metastases. Clin Transl Radiat Oncol 45:100716","journal-title":"Clin Transl Radiat Oncol"},{"issue":"6","key":"1587_CR21","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1016\/j.prro.2023.08.001","volume":"13","author":"A Sahgal","year":"2023","unstructured":"Sahgal A et al (2023) A cancer care ontario consensus-based organizational guideline for the planning and delivery of spine stereotactic body radiation therapy treatment in ontario. Pract Radiat Oncol 13(6):499\u2013509","journal-title":"Pract Radiat Oncol"},{"issue":"4","key":"1587_CR22","doi-asserted-by":"publisher","first-page":"e53","DOI":"10.1002\/mp.12810","volume":"45","author":"M Miften","year":"2018","unstructured":"Miften M et al (2018) Tolerance limits and methodologies for IMRT measurement-based verification QA: recommendations of task group 218. Med Phys 45(4):e53\u2013e83","journal-title":"Med Phys"},{"issue":"9","key":"1587_CR23","doi-asserted-by":"publisher","first-page":"5117","DOI":"10.1118\/1.4960632","volume":"43","author":"JY Huang","year":"2016","unstructured":"Huang JY et al (2016) Approaches to reducing photon dose calculation errors near metal implants. Med Phys 43(9):5117","journal-title":"Med Phys"},{"issue":"6","key":"1587_CR24","doi-asserted-by":"publisher","first-page":"e14276","DOI":"10.1002\/acm2.14276","volume":"25","author":"K Berk","year":"2024","unstructured":"Berk K et al (2024) Efficacious patient-specific QA for vertebra SBRT using a high-resolution detector array SRS mapcheck: AAPM TG-218 analysis. J Appl Clin Med Phys 25(6):e14276","journal-title":"J Appl Clin Med Phys"},{"issue":"1","key":"1587_CR25","doi-asserted-by":"publisher","first-page":"530","DOI":"10.1186\/1471-2407-12-530","volume":"12","author":"M Guckenberger","year":"2012","unstructured":"Guckenberger M et al (2012) Fractionated radiosurgery for painful spinal metastases: DOSIS-a phase II trial. BMC Cancer 12(1):530","journal-title":"BMC Cancer"}],"container-title":["Physical and Engineering Sciences in Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13246-025-01587-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s13246-025-01587-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13246-025-01587-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T08:06:21Z","timestamp":1759997181000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s13246-025-01587-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,21]]},"references-count":25,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["1587"],"URL":"https:\/\/doi.org\/10.1007\/s13246-025-01587-1","relation":{},"ISSN":["2662-4729","2662-4737"],"issn-type":[{"value":"2662-4729","type":"print"},{"value":"2662-4737","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,21]]},"assertion":[{"value":"8 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 June 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 July 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have no relevant financial or non-financial interests to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study did not involve human participants or animal subjects and, therefore, did not require formal ethics committee approval.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}}]}}