Purpose: Vascular access in oncology patients can often be challenging, especially after a few cycles of chemotherapy through peripheral lines which can cause veins to become attenuated. We evaluated the feasibility of centrally placed non-cuffed tunnelled peripherally inserted central catheter in the chest as an alternative to conventional peripherally inserted central catheter. Method: Patients referred for peripherally inserted central catheter found to have inadequate peripheral venous access in their arms due to prior chemotherapy, and therefore they were offered placement of the non-cuffed tunnelled peripherally inserted central catheter in the chest. Adult patients were subjected to the procedure under local anaesthesia, while paediatric patients underwent this procedure under general anaesthesia. Ultrasound guidance was used for venous access, and fluoroscopy was used for tip positioning. Using internal jugular vein access, BARD Groshong-valved 4F peripherally inserted central catheter was placed with its tip in the cavo-atrial junction. Proximal end of the catheter was brought out through the subcutaneous tunnel, so that the exit point of the peripherally inserted central catheter lies over the upper chest. Extra length of the catheter was trimmed, and extensions were attached. The device was stabilized with adhesive and sutures. Results: Out of 19 patients, 18 patients were male (4–72 years). Technical success was achieved in 100% cases. No catheter-related bloodstream infection was noted within 30 days of peripherally inserted central catheter. Overall, during 1966 catheter days, no catheter-related bloodstream infection was observed. The purpose of peripherally inserted central catheter was achieved in 15 patients (78.9%) either in the form of completion of chemotherapy (8/15) or maintained peripherally inserted central catheter line till death (7/15). Partial or complete pullout was observed in four patients (20.1%), which required cuffed tunnelled catheter or implantable port. External fracture was noted in one patient, which was successfully corrected using repair kit. No exit site infection, bleeding, catheter occlusion, catheter dysfunction, venous thrombosis, venous stenosis or catheter embolizations were noted in our series. Conclusion: Centrally placed tunnelled peripherally inserted central catheter is a promising alternative method, when conventional arm peripherally inserted central catheter placement is not feasible. It is an easy and safe procedure that can be performed under local anaesthesia.

Extrapulmonary DICER1‐associated sarcomas (DS) can harbor morphological features overlapping with pleuropulmonary blastoma. We report three children with intracranial and genital tract sarcomas, suspected to have DS based on a heterogeneous yet defining combination of spindle‐cell sarcomatous and blastemal morphology, with rhabdomyomatous differentiation. Foci of immature cartilage at diagnosis (n = 2/3) and increased neuroepithelial differentiation at recurrence (n = 1) were noted. Morphological suspicion prompted somatic testing at reference centers, confirming likely biallelic, loss‐of‐function, and “hotspot” missense DICER1 variants in all three tumors. This can serve as a model for this diagnosis in resource‐limited settings and has implications for germline testing, surveillance, and tumor management.

Radiation therapy is the mainstay in the treatment of head and neck cancers, in addition to surgery and chemotherapy. Expected radiotherapy changes evolving over time may be confused with recurrent tumor. Conversely, even residual or recurrent tumor in the setting of postradiotherapy changes may be difficult to identify clinically or even by radiological imaging. Therefore, it is important to be familiar with the temporal evolution of these changes. The purpose of this pictorial essay is thus to illustrate distinctly the expected radiotherapy changes and radiotherapy-related complications in the head and neck region and to differentiate them from tumor recurrence on routine cross-sectional imaging techniques (computed tomography and magnetic resonance imaging).

Immune-checkpoint inhibitor mediated hepatobiliary injury is an emerging concern in cancer treatment. Most of these adverse reactions are attributed to nivolumab and are characterized by panlobular hepatitis. Large duct cholangiopathy related to these drugs is extremely rare. We present a case of adenocarcinoma of lung treated with pembrolizumab who developed biochemical and imaging features consistent with cholangiopathy characterized by common bile duct dilatation, wall enhancement, and gallbladder wall edema. On follow-up in the fourth month, the imaging features persisted despite the normalization of liver enzymes. To the best of our knowledge, this is the first description of diagnosis and follow-up imaging of pembrolizumab-related cholangiopathy in imaging literature.

Introduction: An organization's transformation from implementation of small, distinct Quality Improvement (QI) efforts to complete incorporation of Quality Improvement Program (QIP) into its culture occurs through a process of churning the foundational elements over time. Aim:To develop a quality culture across the employees, identify measurable indicators and various tools to impart effective quality care and develop a learning culture for continuous quality improvement in the field of imaging services. Materials and Methods:To establish a QIP, the bare minimum requirement started with forming a quality committee. The committee identified the areas of improvement and ascertaining the core principle of Quality Management System (QMS) by having a Quality Manual, Standard Operating Procedures (SOP's), work-instructions, identification and monitoring of quality indicators and a training calendar. Appropriate tools like formatted daily registers, periodic check lists, run charts etc., were developed to collect the data followed by multiple PDSA cycles (Plan, Do, Study and Act) which helped identify the process bottlenecks, followed by implementing solutions and reanalysis.Results: A total of 17 measurable key performance indicators were identified from the four major quality tasks namely Safety, Process Improvement, Professional Outcome and Satisfaction, to assess the performance measures and targets of QIP. Conclusion:Diagnostic services should evaluate how to choose the most appropriate method and develop a comprehensive QIP to meet the needs of the staff and the end users, thus, creating a working environment, where people constitutes the intrinsic value in attaining the ultimate quality and safety.