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The following is a summary of “Challenges and opportunities in the development and clinical implementation of artificial intelligence based synthetic computed tomography for magnetic resonance only radiotherapy,” published in the June 2024 issue of Oncology by Villegas et al.

Synthetic computed tomography (sCT) derived from magnetic resonance imaging (MRI) has the potential to replace traditional planning CT in radiation therapy (RT), effectively eliminating registration uncertainties that arise from multi-modality imaging, reducing costs, and minimizing patient radiation exposure. Currently, CE/FDA-approved sCT solutions are available for the pelvis, brain, and head and neck regions, while advanced deep learning (DL) algorithms are being explored for more complex anatomical sites. Despite the promising advancements, the widespread clinical implementation of sCT faces significant challenges due to the need for standardized guidelines for sCT commissioning and quality assurance (QA). This has resulted in inconsistent sCT practices across various healthcare institutions. To address these challenges, a cohort of experts convened at the ESTRO Physics Workshop 2022 to deliberate on integrating sCT solutions into clinical practice and document the processes and outcomes of these discussions. 

This position paper highlights the critical aspects of sCT development and commissioning, providing a comprehensive overview of the essential elements required to safely and effectively implement an MRI-only RT workflow. Key topics covered include the technical and operational considerations for sCT generation, the establishment of robust QA protocols, and the importance of inter-institutional collaboration to harmonize sCT practices. The paper underscores the need for a consensus on sCT standards to ensure consistent and reliable clinical outcomes. By fostering a unified approach to sCT implementation, this initiative seeks to pave the way for broader adoption of MRI-only RT, ultimately enhancing the precision and efficiency of radiation therapy while improving patient care. 

Through collaborative efforts and shared expertise, the field can advance towards a more standardized and optimized use of sCT, addressing current challenges and unlocking new opportunities for innovation in cancer treatment.

Source: sciencedirect.com/science/article/pii/S0167814024006571