8. Conclusion

Figure 5. Differences in dose calculation of photon beams passing through the metal artifact region. (A) Dose calculation on the artifact-affected computed tomography image. The arrow indicates the titanium insert. (B) Dose calculation on the

Figure 6. Reduction of metal artifacts using a frequency split MAR method. (A) Patient with implanted pedicle screws. (B) Patient with implanted unilateral hip endoprosthesis, Left: original computed tomography image; right: MAR

ground truth computed tomography image without the artifact.

18 Radiotherapy

corrected computed tomography image.

RT plays a central role in the management of painful bone metastasis. Compared with conventional RT, IMRT, or SBRT enables the delivery of higher doses to the target tumor while minimizing the dose to adjacent organs. Not only pain relief but also the restoration of spinal stability and preservation of neurologic function are associated with RT in patients with spinal bone metastases. A multidisciplinary team, especially one consisting of a spinal surgeon and rehabilitation physician, is particularly helpful for treating patients with spinal bone metastases characterized by spinal instability. Reirradiation using IMRT or SBRT is a valuable option for the management of bone metastasis. Future developments in surgical procedures and RT will likely improve the management protocols for bone metastases and technology to reduce metal artifacts in radiation planning might improve the efficacy and safety of combination therapy.
