Robustness evaluation of pencil beam scanning proton therapy treatment planning: A systematic review.

Compared to conventional radiotherapy using X-rays, proton therapy, in principle, allows better conformity of the dose distribution to target volumes, at the cost of greater sensitivity to physical, anatomical, and positioning uncertainties. Robust planning, both in terms of plan optimization and evaluation, has gained high visibility in publications on the subject and is part of clinical practice in many centers. However, there is currently no consensus on the methods and parameters to be used for robust optimization or robustness evaluation. We propose to overcome this deficiency by following the modified Delphi consensus method. This method first requires a systematic review of the literature. We performed this review using the PubMed and Web Of Science databases, via two different experts. Potential conflicts were resolved by a third expert. We then explored the different methods before focusing on clinical studies that evaluate robustness on a significant number of patients. Many robustness assessment methods are proposed in the literature. Some are more successful than others and their implementation varies between centers. Moreover, they are not all statistically or mathematically equivalent. The most sophisticated and rigorous methods have seen more limited application due to the difficulty of their implementation and their lack of widespread availability.

Significance of the tuberculin skin test in pulmonary tuberculosis in Jamaica: comparisons of culture-positive, culture negative and non-tuberculous patients

The results of tuberculin skin tests with PPDS-S done on patients with pulmonary tuberculosis seen over a three-year period (1979-1981) were compared with the results of similar tests done during the same period in a group of persons without tuberculosis. Ninety per cent of patients with culture-positive tuberculosis had positive tuberculin skin tests, compared to 83% of positive tests in the non-tuberculous group. The presence of such a large proportion of positive tuberculin reactions in persons without active disease indicates that the skin test reaction cannot be used on its own to establish the diagnosis of had negative sputum smears and cultures for acid-fast bacilli. Eighty-two per cent of these patients had positive tuberculin skin tests. Invasive diagnostic tests and newer serological diagnostic methods are likely to increase the yield of confirmed positive cases of tuberculosis in the future