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OBJECTIVES: To understand the role of fetal spine position in determining a fetal head position at the time of birth and modality of delivery. PATIENTS AND METHODS: This was a multicenter prospective observational study. Fetal occiput and spine position were evaluated by intrapartum ultrasound. Eighty-six women were eligible for inclusion in the study. Occiput rotational movements and modality of delivery in relation to the fetal spine position were investigated. RESULTS: At the beginning of labor, fetal occiput was in a posterior position in 52.3% of cases and, in 81.5% of cases the spine was in an anterior transverse position. At birth, occiput and spine were both in an anterior position in 90.4% of cases. The rate of cesarean sections in the SP group was significantly higher than the rate in the SAT group (50% vs. 8%, p < 0.0007). Instead, the rate of vaginal deliveries without intervention in the SP group was significantly lower than the rate in the SA group (14% vs. 71%, p < 0.0001). CONCLUSIONS: Fetal spine position could have an important role in determining fetal occiput position at birth. Spine position might play a crucial role in the outcome of delivery. [ABSTRACT FROM AUTHOR]

Introduction The aim of the study is to evaluate whether placental location at term is associated with delivery outcome. Methods A prospective study including 2354 patients with singleton pregnancy at term admitted for vaginal delivery was conducted. Placental position was determined before delivery by ultrasonographic examination performed transabdominally with women in the supine position. Maternal characteristics and delivery outcome such as premature rupture of membranes, induction of labor, mode and gestational age at delivery, indication for cesarean section, duration of the third stage, postpartum hemorrhage (PPH) and manual removal of placenta were correlated with anterior, posterior or fundal placental locations. Results Among women enrolled: i) 1164 had an anterior placenta, ii) 1087 a posterior placenta, iii) 103 a fundal placenta. Women with anterior placenta showed: i) a higher incidence of induction of labor (p = 0.0001), especially for postdate pregnancies and prolonged prelabor rupture of membranes (p < 0.0001), ii) a higher rate of cesarean section rate for failure to progress in labor (p = 0.02), iii) a prolonged third stage (p = 0.01), iv) a higher incidence of manual removal of placenta (p = 0.003) and a higher rate of PPH in vaginal deliveries (p = 0.02). Discussion The present study showed the influence of anterior placental location on the course of labor, with a later onset of labor, a higher rate of induction and cesarean section and postpartum complications. The reason for this influence on labor and delivery complications remains to be elucidated. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate diffusion-weighted imaging (DWI) for assessment of treatment response in locally advanced rectal cancer (LARC) 8 weeks after neoadjuvant chemoradiotherapy (CRT). Methods and materials: A total of 28 patients with LARC underwent magnetic resonance imaging (MRI) prior to and 8 weeks after CRT. Tumor volume (TV) was calculated on T2-weighted MRI scans as well as the apparent diffusion coefficient (ADC) was calculated using Echo-planar DWI-sequences. All data were correlated to surgical results and histopathologic tumor regression grade (TRG), according to Mandard's classification. Post-treatment difference ADC (%ΔADC) and TV (%ΔTV) changes at 8 weeks were compared complete response (CR; TRG1) and non-complete response tumors (non-CR; TRG2–5). Results: The mean % ADC increase of CR group was significantly higher compared to non-CR group (77.2 ± 54.63% vs. 36.0 ± 29.44%; p = 0.05). Conversely, the mean % TV reduction did not significantly differ in CR group from non-CR group (73.7% vs. 63.77%; p = 0.21). Accordingly, the diagnostic accuracy of the mean % ADC increase to discriminate CR from non-CR group was significantly higher than that of the mean % TV reduction (0.913 vs. 0.658; p = 0.022). No correlation was found between mean % TV reduction and TRG (rho = 0.22; p = 0.3037), whereas a negative correlation between mean % ADC increase and TRG was recorded (r = −0.69; p = 0.006). Conclusion: The mean % ADC increase appears to be a reliable tool to differentiate CR from non-CR after CRT in patients with LARC. [ABSTRACT FROM AUTHOR]

Purpose To present In-Vivo Dosimetry (IVD) results obtained elaborating EPID images by a commercial software. Methods 8474 IVD tests for 386 cancer patients treated with 3DCRT, IMRT and VMAT techniques, were performed using the SOFTDISO software. SOFTDISO uses EPID-images to calculate for each beam (i) the R index, i.e. the ratio between daily reconstructed dose and the planned one at isocenter point and (ii) a γ -like analysis between the reference EPID image and that obtained in a daily fraction. γ -like analysis supplies two indexes: the percentage of points with γ < 1 (γ %) and the mean γ value, ( γ mean). For each test, the pass criteria for the signals (S) agreement Δ S% and distance to agreement Δ d, were: 0.95 ⩽ R ⩽ 1.05, γ % ⩾ 90% and γ mean ⩽ 0.5. Results The results of R ratios, the γ -like analysis and the visual inspection of out of tolerance tests, together with the patient anatomical images, permitted to individuate 2 classes of errors: class-1, due to inadequate standard quality controls and class-2, due to patient morphological changes. Depending on the technique and anatomical site, a maximum of 18% of tests had at least one index out of tolerance level (OTL). Once removed the causes of class-1 errors, all patients (except four lung and two breast cancer patients treated with 3DCRT) presented mean indexes values ( R ¯ , γ ¯ % and γ ¯ mean ) within tolerance at the end of treatment course. Class-2 errors were found in some patients. As an example, the Table reports the results of 1810 tests for prostate and H&N tumours treated with VMAT technique with 163 OTL tests (9%). As regards the workload, it took 20 min for 10 patients per day. Conclusions The IVD procedure with SOFTDISO resulted easily implementable and able to individuate errors with a limited workload. [ABSTRACT FROM AUTHOR]