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Woernle A, Englman C, Dickinson L, Kirkham A, Punwani S, Haider A, Freeman A, Kasivisivanathan V, Emberton M, Hines J, Moore CM, Allen C, Giganti F. Picture Perfect: The Status of Image Quality in Prostate MRI. J Magn Reson Imaging 2024; 59:1930-1952. [PMID: 37804007 DOI: 10.1002/jmri.29025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 10/08/2023] Open
Abstract
Magnetic resonance imaging is the gold standard imaging modality for the diagnosis of prostate cancer (PCa). Image quality is a fundamental prerequisite for the ability to detect clinically significant disease. In this critical review, we separate the issue of image quality into quality improvement and quality assessment. Beginning with the evolution of technical recommendations for scan acquisition, we investigate the role of patient preparation, scanner factors, and more advanced sequences, including those featuring Artificial Intelligence (AI), in determining image quality. As means of quality appraisal, the published literature on scoring systems (including the Prostate Imaging Quality score), is evaluated. Finally, the application of AI and teaching courses as ways to facilitate quality assessment are discussed, encouraging the implementation of future image quality initiatives along the PCa diagnostic and monitoring pathway. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Alexandre Woernle
- Faculty of Medical Sciences, University College London, London, UK
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Cameron Englman
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Louise Dickinson
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Centre for Medical Imaging, University College London, London, UK
| | - Aiman Haider
- Department of Pathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Alex Freeman
- Department of Pathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Veeru Kasivisivanathan
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - John Hines
- Faculty of Medical Sciences, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
- North East London Cancer Alliance & North Central London Cancer Alliance Urology, London, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Surgery & Interventional Science, University College London, London, UK
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Barrett T, Lee KL, Illerstam F, Thomsen HS, Jhaveri KS, Løgager V. Interactive training workshop to improve prostate mpMRI knowledge: results from the ESOR Nicholas Gourtsoyiannis teaching fellowship. Insights Imaging 2024; 15:27. [PMID: 38270689 PMCID: PMC10810764 DOI: 10.1186/s13244-023-01574-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 11/05/2023] [Indexed: 01/26/2024] Open
Abstract
PURPOSE Prostate MRI is established for the investigation of patients presenting with suspected early prostate cancer. Outcomes are dependent on both image quality and interpretation. This study assessed the impact of an educational intervention on participants' theoretical knowledge of the technique. METHODS Eighty-one clinicians from two centers with varying experience in prostate MRI participated. Baseline knowledge was assessed with 10 written and image-based multiple-choice questions (MCQs) prior to a course including didactic lectures and hands-on interactive workshops on prostate MRI interpretation. Post-course, participants completed a second 10-question MCQ test, matched by format, themes, and difficulty, to assess for any improvement in knowledge and performance. Results were assessed using the Wilcoxon rank sum test, and the Wilcoxon signed-rank test for paired data. RESULTS Thirty-nine participants, including 25/49 (51.0%) and 14/32 (43.8%) at each center completed both assessments, with their results used for subsequent evaluation. Overall, there was a significant improvement from pre- (4.92 ± 2.41) to post-course scores (6.77 ± 1.46), p < 0.001 and at both Copenhagen (5.92 ± 2.25 to 7.36 ± 1.25) and Toronto (3.14 ± 1.51 to 5.71 ± 1.20); p = 0.005 and p = 0.002, respectively. Participants with no prostate MRI experience showed the greatest improvement (3.77 ± 1.97 to 6.18 ± 1.5, p < 0.001), followed by intermediate level (< 500 MRIs reported) experience (6.18 ± 1.99 to 7.46 ± 1.13, p = 0.058), then advanced (> 500 MRIs reported) experience (6.83 ± 2.48 to 7.67 ± 0.82, p = 0.339). CONCLUSIONS A dedicated prostate MRI teaching course combining didactic lectures and hands-on workshops significantly improved short-term theoretical knowledge of the technique for clinicians with differing levels of experience. CRITICAL RELEVANCE STATEMENT A dedicated teaching course significantly improved theoretical knowledge of the technique particularly for clinicians with less reporting experience and a lower baseline knowledge. The multiple-choice questions format mapped improved performance and may be considered as part of future MRI certification initiatives. KEY POINTS • Prostate MRI knowledge is important for image interpretation and optimizing acquisition sequences. • A dedicated teaching course significantly improved theoretical knowledge of the technique. • Improved performance was more apparent in clinicians with less reporting experience and a lower baseline knowledge.
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Affiliation(s)
- Tristan Barrett
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK.
| | - Kang-Lung Lee
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | | | - Henrik S Thomsen
- Department of Radiology, Herlev Gentofte University Hospital, Herlev, Denmark
| | - Kartik S Jhaveri
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, 610 University Ave, 3-957, Toronto, ON, M5G 2M9, Canada
| | - Vibeke Løgager
- Department of Radiology, Herlev Gentofte University Hospital, Herlev, Denmark
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Purysko AS, Tempany C, Macura KJ, Turkbey B, Rosenkrantz AB, Gupta RT, Attridge L, Hernandez D, Garcia-Tomkins K, Bhargavan-Chatfield M, Weinreb J, Larson DB. American College of Radiology initiatives on prostate magnetic resonance imaging quality. Eur J Radiol 2023; 165:110937. [PMID: 37352683 PMCID: PMC10461171 DOI: 10.1016/j.ejrad.2023.110937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023]
Abstract
Magnetic resonance imaging (MRI) has become integral to diagnosing and managing patients with suspected or confirmed prostate cancer. However, the benefits of utilizing MRI can be hindered by quality issues during imaging acquisition, interpretation, and reporting. As the utilization of prostate MRI continues to increase in clinical practice, the variability in MRI quality and how it can negatively impact patient care have become apparent. The American College of Radiology (ACR) has recognized this challenge and developed several initiatives to address the issue of inconsistent MRI quality and ensure that imaging centers deliver high-quality patient care. These initiatives include the Prostate Imaging Reporting and Data System (PI-RADS), developed in collaboration with an international panel of experts and members of the European Society of Urogenital Radiology (ESUR), the Prostate MR Image Quality Improvement Collaborative, which is part of the ACR Learning Network, the ACR Prostate Cancer MRI Center Designation, and the ACR Appropriateness Criteria. In this article, we will discuss the importance of these initiatives in establishing quality assurance and quality control programs for prostate MRI and how they can improve patient outcomes.
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Affiliation(s)
- Andrei S Purysko
- Section of Abdominal Imaging and Nuclear Radiology Department, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Clare Tempany
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Katarzyna J Macura
- The Russel H. Morgan Department of Radiology and Radiological Science, The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Baris Turkbey
- Molecular Imaging Branch, NCI, NIH, Bethesda, MD, USA
| | | | - Rajan T Gupta
- Departments of Radiology and Surgery and Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University Medical Center, Durham, NC, USA
| | | | | | | | | | - Jeffrey Weinreb
- Department of Radiology, Yale School of Medicine, New Haven, CT, USA
| | - David B Larson
- Department of Radiology, Stanford University, Stanford, CA, USA
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Giganti F, Cole AP, Fennessy FM, Clinton T, Moreira PLDF, Bernardes MC, Westin CF, Krishnaswamy D, Fedorov A, Wollin DA, Langbein B, Frego N, Labban M, Badaoui JS, Chang SL, Briggs LG, Tokuda J, Ambrosi A, Kirkham A, Emberton M, Kasivisvanathan V, Moore CM, Allen C, Tempany CM. Promoting the use of the PI-QUAL score for prostate MRI quality: results from the ESOR Nicholas Gourtsoyiannis teaching fellowship. Eur Radiol 2023; 33:461-471. [PMID: 35771247 PMCID: PMC9244244 DOI: 10.1007/s00330-022-08947-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/22/2022] [Accepted: 05/25/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The Prostate Imaging Quality (PI-QUAL) score is a new metric to evaluate the diagnostic quality of multiparametric magnetic resonance imaging (MRI) of the prostate. This study assesses the impact of an intervention, namely a prostate MRI quality training lecture, on the participant's ability to apply PI-QUAL. METHODS Sixteen participants (radiologists, urologists, physicists, and computer scientists) of varying experience in reviewing diagnostic prostate MRI all assessed the image quality of ten examinations from different vendors and machines. Then, they attended a dedicated lecture followed by a hands-on workshop on MRI quality assessment using the PI-QUAL score. Five scans assessed by the participants were evaluated in the workshop using the PI-QUAL score for teaching purposes. After the course, the same participants evaluated the image quality of a new set of ten scans applying the PI-QUAL score. Results were assessed using receiver operating characteristic analysis. The reference standard was the PI-QUAL score assessed by one of the developers of PI-QUAL. RESULTS There was a significant improvement in average area under the curve for the evaluation of image quality from baseline (0.59 [95 % confidence intervals: 0.50-0.66]) to post-teaching (0.96 [0.92-0.98]), an improvement of 0.37 [0.21-0.41] (p < 0.001). CONCLUSIONS A teaching course (dedicated lecture + hands-on workshop) on PI-QUAL significantly improved the application of this scoring system to assess the quality of prostate MRI examinations. KEY POINTS • A significant improvement in the application of PI-QUAL for the assessment of prostate MR image quality was observed after an educational intervention. • Appropriate training on image quality can be delivered to those involved in the acquisition and interpretation of prostate MRI. • Further investigation will be needed to understand the impact on improving the acquisition of high-quality diagnostic prostate MR examinations.
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Affiliation(s)
- Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK.
- Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley St., W1W 7TS, London, UK.
| | - Alexander P Cole
- Division of Urological Surgery, Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Fiona M Fennessy
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Timothy Clinton
- Division of Urological Surgery, Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Mariana Costa Bernardes
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carl-Fredrik Westin
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Deepa Krishnaswamy
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andriy Fedorov
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel A Wollin
- Division of Urological Surgery, Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bjoern Langbein
- Division of Urological Surgery, Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicola Frego
- Division of Urological Surgery, Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Muhieddine Labban
- Division of Urological Surgery, Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joy S Badaoui
- Division of Urological Surgery, Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven L Chang
- Division of Urological Surgery, Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Logan G Briggs
- Division of Urological Surgery, Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Junichi Tokuda
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Alex Kirkham
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley St., W1W 7TS, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Veeru Kasivisvanathan
- Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley St., W1W 7TS, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley St., W1W 7TS, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clare M Tempany
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Are Urologists Ready for Interpretation of Multiparametric MRI Findings? A Prospective Multicentric Evaluation. Diagnostics (Basel) 2022; 12:diagnostics12112656. [PMID: 36359499 PMCID: PMC9689928 DOI: 10.3390/diagnostics12112656] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
Aim: To assess urologists’ proficiency in the interpretation of multiparametric magnetic resonance imaging (mpMRI). Materials and Methods: Twelve mpMRIs were shown to 73 urologists from seven Italian institutions. Responders were asked to identify the site of the suspicious nodule (SN) but not to assign a PIRADS score. We set an a priori cut-off of 75% correct identification of SN as a threshold for proficiency in mpMRI reading. Data were analyzed according to urologists’ hierarchy (UH; resident vs. consultant) and previous experience in fusion prostate biopsies (E-fPB, defined as <125 vs. ≥125). Additionally, we tested for differences between non-proficient vs. proficient mpMRI readers. Multivariable logistic regression analyses (MVLRA) tested potential predictors of proficiency in mpMRI reading. Results: The median (IQR) number of correct identifications was 8 (6−8). Anterior nodules (number 3, 4 and 6) represented the most likely prone to misinterpretation. Overall, 34 (47%) participants achieved the 75% cut-off. When comparing consultants vs. residents, we found no differences in terms of E-fPB (p = 0.9) or in correct identification rates (p = 0.6). We recorded higher identification rates in urologists with E-fBP vs. their no E-fBP counterparts (75% vs. 67%, p = 0.004). At MVLRA, only E- fPB reached the status of independent predictor of proficiency in mpMRI reading (OR: 3.4, 95% CI 1.2−9.9, p = 0.02) after adjusting for UH and type of institution. Conclusions: Despite urologists becoming more familiar with interpretation of mpMRI, their results are still far from proficient. E-fPB enhances the proficiency in mpMRI interpretation.
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Giganti F, Aupin L, Thoumin C, Faouzi I, Monnier H, Fontaine M, Navidi A, Ritvo PG, Ong V, Chung C, Bibi I, Lehrer R, Hermieu N, Barret E, Ambrosi A, Kasivisvanathan V, Emberton M, Allen C, Kirkham A, Moore CM, Renard-Penna R. Promoting the use of the PRECISE score for prostate MRI during active surveillance: results from the ESOR Nicholas Gourtsoyiannis teaching fellowship. Insights Imaging 2022; 13:111. [PMID: 35794256 PMCID: PMC9259779 DOI: 10.1186/s13244-022-01252-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/11/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives The PRECISE criteria for serial multiparametric magnetic resonance imaging (MRI) of the prostate during active surveillance recommend the use of a dedicated scoring system (PRECISE score) to assess the likelihood of clinically significant radiological change. This pilot study assesses the effect of an interactive teaching course on prostate MRI during active surveillance in assessing radiological change in serial imaging. Methods Eleven radiology fellows and registrars with different experience in prostate MRI reading participated in a dedicated teaching course where they initially evaluated radiological change (based on their previous training in prostate MRI reading) independently in fifteen patients on active surveillance (baseline and follow-up scan), and then attended a lecture on the PRECISE score. The initial scans were reviewed for teaching purposes and afterwards the participants re-assessed the degree of radiological change in a new set of images (from fifteen different patients) applying the PRECISE score. Receiver operating characteristic analysis was performed. Confirmatory biopsies and PRECISE scores given in consensus by two radiologists (involved in the original draft of the PRECISE score) were the reference standard.
Results There was a significant improvement in the average area under the curve (AUC) for the assessment of radiological change from baseline (AUC: 0.60 [Confidence Intervals: 0.51–0.69] to post-teaching (AUC: 0.77 [0.70–0.84]). This was an improvement of 0.17 [0.016–0.28] (p = 0.004).
Conclusions A dedicated teaching course on the use of the PRECISE score improves the accuracy in the assessment of radiological change in serial MRI of the prostate.
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Affiliation(s)
- Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK. .,Division of Surgery and Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley St., London, W1W 7TS, UK.
| | - Laurene Aupin
- AP-HP, Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Camille Thoumin
- AP-HP, Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Ingrid Faouzi
- AP-HP, Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Hippolyte Monnier
- AP-HP, Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Matthieu Fontaine
- AP-HP, Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Alexandre Navidi
- AP-HP, Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Paul-Gydéon Ritvo
- AP-HP, Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Valentin Ong
- AP-HP, Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Cecile Chung
- AP-HP, Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Imen Bibi
- AP-HP, Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Raphaële Lehrer
- AP-HP, Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Nicolas Hermieu
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Eric Barret
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | - Veeru Kasivisvanathan
- Division of Surgery and Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley St., London, W1W 7TS, UK.,Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley St., London, W1W 7TS, UK.,Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Caroline M Moore
- AP-HP, Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.,Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
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Kwee TC, Kwee RM. Workload of diagnostic radiologists in the foreseeable future based on recent scientific advances: growth expectations and role of artificial intelligence. Insights Imaging 2021; 12:88. [PMID: 34185175 PMCID: PMC8241957 DOI: 10.1186/s13244-021-01031-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/08/2021] [Indexed: 12/13/2022] Open
Abstract
Objective To determine the anticipated contribution of recently published medical imaging literature, including artificial intelligence (AI), on the workload of diagnostic radiologists. Methods This study included a random sample of 440 medical imaging studies published in 2019. The direct contribution of each study to patient care and its effect on the workload of diagnostic radiologists (i.e., number of examinations performed per time unit) was assessed. Separate analyses were done for an academic tertiary care center and a non-academic general teaching hospital. Results In the academic tertiary care center setting, 65.0% (286/440) of studies could directly contribute to patient care, of which 48.3% (138/286) would increase workload, 46.2% (132/286) would not change workload, 4.5% (13/286) would decrease workload, and 1.0% (3/286) had an unclear effect on workload. In the non-academic general teaching hospital setting, 63.0% (277/240) of studies could directly contribute to patient care, of which 48.7% (135/277) would increase workload, 46.2% (128/277) would not change workload, 4.3% (12/277) would decrease workload, and 0.7% (2/277) had an unclear effect on workload. Studies with AI as primary research area were significantly associated with an increased workload (p < 0.001), with an odds ratio (OR) of 10.64 (95% confidence interval (CI) 3.25–34.80) in the academic tertiary care center setting and an OR of 10.45 (95% CI 3.19–34.21) in the non-academic general teaching hospital setting. Conclusions Recently published medical imaging studies often add value to radiological patient care. However, they likely increase the overall workload of diagnostic radiologists, and this particularly applies to AI studies. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-021-01031-4.
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Affiliation(s)
- Thomas C Kwee
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Robert M Kwee
- Department of Radiology, Zuyderland Medical Center, Heerlen, Sittard-Geleen, The Netherlands
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Gómez Rivas J, Carrion DM, Chandrasekar T, Álvarez-Maestro M, Enikeev D, Martínez-Piñeiro L, Barret E. The role of multiparametric magnetic resonance imaging in the selection and follow-up of patients undergoing active surveillance for prostate cancer. An European Section of Uro-Technology (ESUT) review. Actas Urol Esp 2021; 45:188-197. [PMID: 33189417 DOI: 10.1016/j.acuro.2020.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION In recent years, active surveillance (AS) has gained popularity as a safe and reasonable option for patients with low-risk, clinically localized prostate cancer. OBJECTIVE To summarize the latest information regarding the use of mpMRI in the setting of active surveillance (AS) for the management of prostate cancer (PCa). EVIDENCE ACQUISITION A PubMed-based, English literature search was conducted through February 2020. We selected the most relevant original articles, meta-analyses and systematic reviews that could provide important information. EVIDENCE SYNTHESIS The great importance of mpMRI of the prostate in the setting of PCa diagnosis is its ability to visualize primarily high-grade cancerous lesions potentially missed on systematic biopsies. In several studies, mpMRI has shown an improved performance over clinically based models for identifying candidates which will benefit the most from AS. Although data on prostate mpMRI during follow-up of men under AS is sparse, it holds the probability to improve significantly AS programs by a more precise selection of optimal candidates, a more accurate identification of disease progression and a reduction in number of biopsies. The goal of reassessment of patients undergoing AS is to find the most effective moment to change attitude to active treatment. CONCLUSION The value of mpMRI has been recognized due to its high negative predictive value (NPV) for lesion upgrading in low-risk PCa patients. The improvement in imaging detection, and precise diagnosis with mpMRI could reduce misclassifications at initial diagnosis and during follow-up, reducing the number of biopsies.
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Affiliation(s)
- J Gómez Rivas
- Departamento de Urología, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación para la Salud, Hospital Universitario La Paz (IdiPaz), Madrid, España.
| | - D M Carrion
- Departamento de Urología, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación para la Salud, Hospital Universitario La Paz (IdiPaz), Madrid, España
| | - T Chandrasekar
- Departamento de Urología, Hospital Universitario Thomas Jefferson, Filadelfia, EE. UU
| | - M Álvarez-Maestro
- Departamento de Urología, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación para la Salud, Hospital Universitario La Paz (IdiPaz), Madrid, España
| | - D Enikeev
- Instituto de Urología y Salud Reproductiva, Universidad Sechenov, Moscú, Rusia
| | - L Martínez-Piñeiro
- Departamento de Urología, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación para la Salud, Hospital Universitario La Paz (IdiPaz), Madrid, España
| | - E Barret
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
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Stanzione A, Creta M, Imbriaco M, La Rocca R, Capece M, Esposito F, Imbimbo C, Fusco F, Celentano G, Napolitano L, Mangiapia F, Mirone V, Longo N. Attitudes and perceptions towards multiparametric magnetic resonance imaging of the prostate: A national survey among Italian urologists. ACTA ACUST UNITED AC 2020; 92. [PMID: 33348956 DOI: 10.4081/aiua.2020.4.291] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/03/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We aimed to assess the attitudes and perceptions towards multiparametric magnetic resonance imaging (mpMRI) of the prostate among Italian urologists. MATERIAL AND METHODS A national, web-based survey was performed. A questionnaire composed of 18 multiple choice questions was e-mailed to 941 currently active urologists, members of the Italian Society of Urology. Preserving anonymity, respondents' demographics were collected (e.g. geographic region, type of workplace, prostate procedures performed) as well as data concerning their attitudes and perceptions towards mpMRI (e.g. indications deemed appropriate, degree of confidence in mpMRI results). Data were expressed as raw numbers and percentages of survey answers. RESULTS In total, 98 responses were received (participation rate = 10.4%). Respondents mostly worked in urban areas (96%) and primarily in hospital settings (89%), while 48% of them worked in southern Italy. 97% of respondents considered mpMRI useful to detect Prostate Cancer (PCa) in patients with prior negative biopsy, 64% in biopsy-naïve patients and 60% for PCa pre-operatory staging. About half (42%) of the participants declared that mpMRI results frequently lead them to change PCa management strategy. Standardization of mpMRI acquisition and reporting was partially unsatisfactory. Reported waiting time for mpMRI scans was longer than 4 weeks for 51% of respondents. The major limitation of this survey includes the small number of participants. CONCLUSIONS Prostate mpMRI is used by Italian urologists mainly for detection and for pre-operative staging of PCa. Further improvements in terms of mpMRI availability and report standardization are required.
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Affiliation(s)
- Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples.
| | - Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples.
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples.
| | - Roberto La Rocca
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples.
| | - Marco Capece
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples.
| | - Fabio Esposito
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy..
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples.
| | - Ferdinando Fusco
- Department of Woman Child and of General and Specialist Surgery, University of Campania "Luigi Vanvitelli", Naples.
| | - Giuseppe Celentano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples.
| | - Luigi Napolitano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples.
| | - Francesco Mangiapia
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples.
| | - Vincenzo Mirone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples.
| | - Nicola Longo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples.
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PI-RADS Version 2.1: A Critical Review, From the AJR Special Series on Radiology Reporting and Data Systems. AJR Am J Roentgenol 2020; 216:20-32. [PMID: 32997518 DOI: 10.2214/ajr.20.24495] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PI-RADS version 2.1 updates the technical parameters for multiparametric MRI (mpMRI) of the prostate and revises the imaging interpretation criteria while maintaining the framework introduced in version 2. These changes have been considered an improvement, although some issues remain unresolved, and new issues have emerged. Areas for improvement discussed in this review include the need for more detailed mpMRI protocols with optimization for 1.5-T and 3-T systems; lack of validation of revised transition zone interpretation criteria and need for clarifications of the revised DWI and dynamic contrast-enhanced imaging criteria and central zone (CZ) assessment; the need for systematic evaluation and reporting of background changes in signal intensity in the prostate that can negatively affect cancer detection; creation of a new category for lesions that do not fit into the PI-RADS assessment categories (i.e., PI-RADS M category); inclusion of quantitative parameters beyond size to evaluate lesion aggressiveness; adjustments to the structured report template, including standardized assessment of the risk of extraprostatic extension; development of parameters for image quality and performance control; and suggestions for expansion of the system to other indications (e.g., active surveillance and recurrence).
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11
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Walker SM, Türkbey B. PI-RADSv2.1: Current status. Turk J Urol 2020; 47:S45-S48. [PMID: 33052842 DOI: 10.5152/tud.2020.20403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 09/03/2020] [Indexed: 12/24/2022]
Abstract
Multiparametric magnetic resonance imaging (mpMRI) has played an increasing role in the detection and local staging of prostate cancer over the last 15 years. Prostate mpMRI, due to various factors, is prone to high inter-reader variability necessitating standardized reporting guidelines that provide accurate and actionable information to the ordering clinician. The Prostate Imaging-Reporting and Data System version 2.1 (PI-RADSv2.1) was released in March 2019 as an update to PI-RADSv2.0 with the hope of further standardizing the reporting process of prostate mpMRI, improving the detection of clinically significant cancer, reducing the biopsy rate of indolent tumors, and decreasing inter-reader variability. Early data show an improved performance of PI-RADSv2.1 over PI-RADSv2.0. Updates included in PI-RADSv2.1 and its current experience in clinic will be reviewed in this review.
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Affiliation(s)
- Stephanie M Walker
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Barış Türkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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12
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O'Connor L, Wang A, Walker SM, Yerram N, Pinto PA, Turkbey B. Use of multiparametric magnetic resonance imaging (mpMRI) in localized prostate cancer. Expert Rev Med Devices 2020; 17:435-442. [PMID: 32275845 DOI: 10.1080/17434440.2020.1755257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Prostate magnetic resonance imaging (MRI) is commonly used for localized disease mainly to detect intraprostatic lesions and to guide biopsies. Despite its documented success in clinical practice, limitations still exist for prostate MRI. In this review, we discuss common clinical uses of prostate MRI, its limitations, and potential solutions for those limitations.Areas covered: Current uses of prostate MRI and challenges discussed. Literature search in PubMed was completed using the keywords "prostate MRI, prostate cancer."Expert opinion: Prostate MRI is a useful method for localization, biopsy, and treatment guidance of prostate cancer. Certain limitations of prostate MRI such as false negatives due to spatial resolution and relatively low repeatability between different radiologists can potentially be solved by investing more on education training and artificial intelligence technology.
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Affiliation(s)
- Luke O'Connor
- Urologic Oncology Branch, NCI, NIH, Bethesda, MD, USA
| | - Alex Wang
- Urologic Oncology Branch, NCI, NIH, Bethesda, MD, USA
| | | | - Nitin Yerram
- Urologic Oncology Branch, NCI, NIH, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, NCI, NIH, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Program, NCI, NIH, Bethesda, MD, USA
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Abstract
PURPOSE OF REVIEW The use of MRI in the early detection of prostate cancer (PCa) is increasing rapidly. In the last couple of years, there have been a number of key publications that have led to its adoption in the UK and European guidelines. RECENT FINDINGS PROMIS showed that standard biopsy missed up to half of clinically significant disease, compared with 5 mm template mapping biopsy. Three studies then compared the standard transrectal ultrasound (TRUS) pathway with an MRI with or without targeted biopsy pathway. These showed that MRI-targeted biopsies detect more clinically significant disease and reduce overdetection of indolent disease whilst allowing between one-third to one half of men to avoid an immediate biopsy. Cost-effectiveness data show that using MRI to determine who gets a biopsy and how that biopsy is done is a cost-neutral approach when men at lowest risk do not undergo biopsy. SUMMARY Prostate MRI is a useful and cost-effective tool for early detection of PCa that minimizes the impact of overdetection and overtreatment whilst maximizing the detection of PCa, which could benefit from treatment. The next challenge is to ensure that centres offering MRI are able to offer high-quality MRI acquisition and reporting.
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14
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Wang NN, Fan RE, Ghanouni P, Sonn GA. Teaching Urologists "How to Read Multi-Parametric Prostate MRIs Using PIRADSv2": Results of an iBook Pilot Study. Urology 2019; 131:40-45. [PMID: 31150691 DOI: 10.1016/j.urology.2019.04.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/08/2019] [Accepted: 04/17/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To create an online resource that teaches urologists how to interpret prostate multiparametric magnetic resonance imaging (mpMRI). As prostate mpMRI becomes widely adopted for cancer diagnosis and targeted biopsy, it is increasingly important that urologists are comfortable and experienced in assessing the images. The purpose of this study was to create an online mpMRI ibook and measure its effect on instilling proficiency among urology residents. METHODS We created a case-based ibook aimed at teaching clinicians how to identify and score prostate lesions on mpMRI using the Prostate Imaging-Reporting and Data System (PIRADS) v2. Residents completed a 43-question pretest before gaining access to the ibook for 1 month. The test asks participants to identify and score visible lesions using interactive mpMRI images. After a formal review of the material, they completed a post-test. Participants also rated their diagnostic confidence on a scale of 1-10 before and after reviewing the ibook. The change in performance and confidence scores for each resident was compared using Wilcoxon signed-rank test. RESULTS Eleven urology residents completed the pretest, review session and post-test. The mean test score rose from 37% (median 40%) to 57% (median 58%) after reviewing the ibook. Improvement was significant (P= .0039). Confidence scores also improved (P = .001). CONCLUSION We created an interactive ibook that teaches urologists how to evaluate prostate mpMRIs and demonstrated improved performance in interpretation among urology residents. This effective module can be incorporated into resident education on a national level and offered as a self-teaching resource for practicing urologists.
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Affiliation(s)
- Nancy N Wang
- Department of Urology, Stanford University School of Medicine, Stanford, CA.
| | - Richard E Fan
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | | | - Geoffrey A Sonn
- Department of Urology, Stanford University School of Medicine, Stanford, CA; Department of Radiology, Stanford University, Stanford, CA
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