ACR Collaborative Model Achieves 20 Percent Improvement in PI-QUAL Scores for Prostate MRI

A multisite study, commissioned by the American College of Radiology (ACR) to address the quality of prostate magnetic resonance imaging (MRI) exams, found that a collaborative learning network model achieved significant increases in Prostate Imaging Quality (PI-QUAL) scores > 4 for prostate MRI and quality sequences for diffusion-weighted imaging MRI (DWI-MRI) scans.

For the study, recently published in the Journal of the American College of Radiology, researchers from the radiology departments of five organizations participated in the ACR Prostate MR Image Quality Improvement Collaborative. Employing a structured problem-solving approach to address variability with prostate MRI quality, the researchers discussed common challenges and utilized modified PI-QUAL parameters to comply with PI-RADS v2.1.

At the end of the 52-week study, the mean weekly rate of PI-QUAL scores > 4 for audited prostate MRI exams was 87 percent, a 20 percent improvement from the baseline of 67 percent. For the three organizations that evaluated quality with DWI-MRI exams, the percentage of adequate sequences increased 23 percent from a baseline of 57 percent to 80 percent by the conclusion of the study.

“In this work, we confirm this variability (with prostate MRI quality) across the participating organizations and show that a learning network model where multiple organizations share knowledge and work together toward a common goal could improve prostate MR image quality at multiple sites simultaneously,” wrote lead study author Andrei S. Purysko, M.D., FASR, who is the section head of abdominal imaging with the Imaging Institute at the Cleveland Clinic in Ohio, and colleagues.

The researchers noted that lack of quality imaging standards and geometric distortion of MRI DWI due to rectal air were noted by all five organizations as contributing factors to reduced quality with prostate MRI scans. Four of the five organizations also cited non-compliance with PI-RADS technical standards.

Interventions included protocol changes, such as increasing spatial resolution on MRI DWI, improvements in patient preparation, such as standardized prep instructions with enema and dietary restrictions, and personnel training, which included PI-QUAL training and other initiatives such as training on imaging quality metrics for MRI technologists, according to the researchers.

(Editor's note: For additional content on prostate cancer imaging, click here.)

In regard to the evaluation of MRI DWI quality, the study authors noted two organizations that included enema in their patient preparation instructions achieved 26 percent and 17 percent increases, respectively, in the percentage of quality MRI DWI sequences. The one organization that didn’t emphasize enema as part of the patient preparation saw a 12 percent decline in MRI DWI image quality, according to the researchers.

“Together, these findings highlight the importance of patient preparation and the benefits of enema, which have been previously reported,” pointed out Purysko and colleagues. “However, the measures have not been broadly adopted in clinical practice due to concerns about patient discomfort and effectiveness.”

(Editor’s note: For related content, see “Going Beyond PI-RADS: A Closer Look at Emerging Prostate MRI Scoring Systems,” “Multinational Study Suggests High Variability with Quality of Prostate MRI” and “Seven Takeaways from Recent Review on Prostate MRI Imaging Quality.”)

The researchers did concede challenges with the study, noting that many of the participants lacked experience with quality improvement methodology and MR technologist shortages limited time that could be devoted to the study.

However, the study authors also noted that the majority of study participants said quality initiatives enhanced their abilities and led to shorter MRI exam times with one organization estimating 325 hours in time saved for their MRI scanner.

“Given the increasing use of prostate MRI in clinical practice, widespread adoption of the methods developed by the participating sites can potentially benefit hundreds of thousands of patients in the U.S. annually,” posited Purysko and colleagues.