Dosimetric characterization of carbon fiber stabilization devices for post-operative particle therapy

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

“…Mastella et al demonstrated the higher image quality by measuring remarkably smaller variations of CT values of the same region in proximity of carbon screws. 30 Moreover, they noted improved planning accuracy for proton therapy with CFP implants, concluding that with carbon implants patients have greater flexibility for future RT treatmentsa consideration with which we completely agree with. Weighing aspects of the benefit of particle therapy due to higher applicable doses against uncertainties caused by metallic implants and the correlated risk for local failure or OAR complications, as well as the search for methods to reduce uncertainties and their clinical risks, could be of the past if metallic implants were fully exchanged by carbon-based materials, provided that the clinical outcome from the neurosurgical perspective is maintained.…”

“…With its low atomic number, carbon-based materials have favorable radiation properties compared to stainless steel and titanium alloy (Ti) implants and therefore have raised researcher's interest in the field of RT. [28][29][30] Previously published measurements and simulations of proton and photon beam behavior through CFP compared to typical surgical metal implants underlined along with other investigations the promising properties of CFP implants. [28][29][30] Although carbonic screws are also affected by HU uncertainties, as any component of the human body is, especially dense bones, associated uncertainties are considered to be remarkably smaller than those of high Z materials.…”

“…The large number of patients who are affected by surgical implants and its potential for RTespecially for particle RT where dose distributions crucially depend on correct CT valueshave made these neurosurgical developments to an active field of research 26,[28][29][30]. Recent publications confirmed advantages of CFP Dose to healthy tissue for both initial plan types and screw systems, quantified by the mean and D2 to the structure PTV ring (5 cm margin surrounding the PTV + 5 mm).…”

Strahlentherapie spinaler Tumoren

“…Eine Absprache sollte bereits präoperativ erfolgen, da dann durch die Verwendung von PEEK bzw. carbonverstärkten Schrauben die Planung einer Partikeltherapie erleichtert werden kann [10].…”

“…Ebenso kann durch die Verwendung von Carbonfaser-verstärkten Pedikelschrauben bei der dorsalen Stabilisierung bzw. von Polyetheretherketonen (PEEK) beim Wirbelkörperersatz (WKE) die Artefakt-Last bei der Bestrahlungsplanung gesenkt werden, was auch die Exaktheit der Dosisberechnung verbessert [10]. Selbstverständlich verbessert sich durch diese Form der Artefakt-Reduktion auch die Möglichkeit der nachfolgenden bildgebenden Verlaufskontrolle.…”