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Practical considerations for handling implants in proton therapy.

Gloria Vilches-Freixas1, Vicki Trier Taasti1,2, Ilaria Rinaldi1

  • 1Department of Radiation Oncology (Maastro), GROW Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands.

Journal of Applied Clinical Medical Physics
|October 30, 2025
PubMed
Summary
This summary is machine-generated.

Managing medical implants in proton therapy is crucial for accurate dose calculations. Small implants can use standard CT curves, while large implants require material overrides to ensure patient safety and effective treatment.

Keywords:
CT image artifactsclinical instructionsmetal implantsproton therapy

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Medical Imaging

Background:

  • Computed tomography (CT) simulation is standard for proton therapy planning.
  • Non-tissue-like materials and high-Z metal implants cause CT artifacts, impacting dose calculation accuracy.
  • These inaccuracies affect both proton therapy planning and dose delivery.

Purpose of the Study:

  • To outline clinical procedures for managing medical implants during proton therapy.
  • To address challenges posed by implants in CT-based treatment planning.

Main Methods:

  • Categorized implants into 'small' and 'large' based on size and image impact.
  • Conducted patient dose evaluations to assess implant influence.
  • Considered CT window-level settings, material overrides, and artifact mitigation.

Main Results:

  • Small titanium/tantalum implants do not require material overrides.
  • Large implants (silicone, metal prostheses, air pockets) necessitate material overrides for accurate stopping-power ratios.
  • Avoidance of proton beams passing through metal implants is recommended.

Conclusions:

  • A standardized strategy for managing implants in proton therapy has been developed.
  • Procedures are based on clinical experience and dose evaluations.
  • These insights can assist other centers in refining implant management protocols.