4 key factors that impact prostate MRI quality
Radiologists are sharing four key drivers that can help to improve prostate magnetic resonance imaging quality.
MRI is an essential tool for diagnosing and managing the disease, but poor image quality and interpretation variability continue to hinder its widespread adoption, experts write in RadioGraphics. This prompted the American College of Radiology (ACR) in 2021 to launch the Prostate MR Image Quality Improvement Collaborative, which now includes 14 organizations across three cohorts.
Those involved shared some of the key lessons learned in a new analysis, published by the Radiological Society of North America (RSNA) on Dec. 4.
“High quality prostate MR images are essential for prostate cancer workup and management,” lead author Andrei S. Purysko, MD, section head of abdominal imaging with the Cleveland Clinic, and colleagues wrote. “The framework created by the ACR's Prostate MR Image Quality Improvement Collaborative proved to be effective in helping organizations obtain high quality prostate MR images. Although the interventions described herein can be used by organizations striving to achieve high quality examinations consistently, such optimization is not a one-time activity.”
The initiative focused on training organizations using structured improvement methods. All organizations participate in 10 two-hour sessions to learn about key concepts around prostate MRI quality. They utilized the A3 method—a structured problem-solving approach that uses a structured quality improvement template to facilitate documentation, build consensus and communicate progress.
Participants audited images using the Prostate Imaging Quality system’s (or PI-QUAL) five-point scale. A total of 13 organizations successfully completed the program, collectively auditing 7,805 prostate MRI exams. Over the course of the initiative, the percentage of scans rated with a PI-QUAL score greater than or equal to 4 (signaling optimal quality) rose from 68% at baseline to 87% by the program’s conclusion, Purysko and co-authors reported.
“To our knowledge, these sites now represent some of the highest-performing institutions in prostate MRI nationwide,” they wrote. “These sites’ journey required substantial effort and commitment, but in the process they gained invaluable, practical expertise in achieving and sustaining excellence in prostate MRI,” the authors added later.
From their work, the collaborative identified four key drivers necessary for consistently obtaining high quality prostate images. These included:
1. Protocol optimization: Failure to comply with Prostate Imaging Reporting and Data System (PI-RADS) technical standards often limits exam reproducibility. It also negatively impacts cancer detection and localization, including comparisons with future follow-up studies. Potential interventions to optimize protocols include eliminating unnecessary sequences, incorporating AI-augmented ones, avoiding repeated diffusion-weighted imaging after administering IV contrast material, and more.
2. Patient preparation: When evaluating procedures and interviewing techs and referring providers, researchers discovered that pre-exam instructions often were inconsistent, unclear and frequently overlooked. Rectal gas and motion were the most common reasons for poor image quality, as identified across multiple participating groups. Interventions have included advising patients to use a saline enema 2 to 3 hours before imaging, avoiding eating or drinking for 6 to 8 hours beforehand, sending prep instructions 48 to 72 hours prior to the exam, explaining the importance of prep, and asking patients to use the restroom.
3. Personnel training: The collaborative discovered a knowledge gap among imaging staff about the importance of image quality and prep, which was a key contributor to suboptimal results. Targeted interventions have included training technologists to recognize and troubleshoot image artifacts, creating reference materials with examples of high quality images, training radiologists and techs on how to use PI-QUAL, and performing periodic image reviews.
4: Performance monitoring and feedback: Data collection from auditing of prostate MRI exams is a “critical step” in identifying factors that contribute to poor image quality. Interventions can include incorporating Prostate Imaging Quality system scores in radiology reports and creating an image quality dashboard to track results.
“Every organization is different in its clinical views, opinions, values, and constraints, and as technology evolves, the environment will continue to change,” the authors emphasized. “That is why optimization is an ongoing process of evaluation and reevaluation to sustain desired outcomes. By implementing the improvement framework described herein, organizations can optimize their MRI protocols in the context of their individual environment.”
Read much more in the open access RadioGraphics study. Purysko and colleagues also previously detailed some of their early findings in a study published last year, which estimated one site realized about $559,000 in reimbursement gains by implementing these updates.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.