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New in Advances in Radiation Oncology: Titanium vs Carbon/PEEK spinal implants in postoperative spine SBRT: a review of imaging, dosimetry, and clinical evidence. Key finding: Carbon/PEEK reduces CT artifact volume up to ~90% and cuts photon max dose perturbation from ~30% to ~5%; in protons, CTV underdose error drops from 17.3% to 4.1%, near implant-free levels. Why it matters: artifacts complicate contouring and dose calculation exactly where ablative dose meets spinal cord, and cleaner imaging helps detect recurrence earlier. Important caveat: clinical outcome data remain retrospective and limited; no direct contouring-accuracy comparisons exist, and Carbon/PEEK costs more. Bottom line: the dosimetric advantages are consistent and real, but improved local control is not yet proven. Randomized data (CarbonS trial) are coming. @ASTRO_org #RadOnc# #OncTwitter#