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Long-distance longitudinal prostate MRI quality assurance: from startup to 12 months

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Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate a 12-month long-distance prostate MRI quality assurance (QA) program.

Methods

The need for IRB approval was waived for this prospective longitudinal QA effort. One academic institution experienced with prostate MRI [~ 1000 examinations/year (Site 2)] partnered with a private institution 240 miles away that was starting a new prostate MRI program (Site 1). Site 1 performed all examinations (N = 249). Four radiologists at Site 1 created finalized reports, then sent images and reports to Site 2 for review on a rolling basis. One radiologist at Site 2 reviewed findings and exam quality and discussed results by phone (~ 2–10 minutes/MRI). In months 1–6 all examinations were reviewed. In months 7–12 only PI-RADS ≤ 2 and ‘difficult’ cases were reviewed. Repeatability was assessed with intra-class correlation (ICC). ‘Clinically significant cancer’ was Gleason ≥ 7.

Results

Image quality significantly (p < 0.001) improved after the first three months. Inter-rater agreement also improved in months 3–4 [ICC: 0.849 (95% CI 0.744–0.913)] and 5–6 [ICC: 0.768 (95% CI 0.619–0.864)] compared to months 1–2 [ICC: 0.621 (95% CI 0.436–0.756)]. PI-RADS ≤ 2 examinations were reclassified PI-RADS ≥ 3 in 19% (30/162); of these, 23 had post-MRI histology and 57% (13/23) had clinically significant cancer (5.2% of 249). False-negative examinations [N = 18 (PI-RADS ≤ 2 and Gleason ≥ 7)] were more common at Site 1 during months 1–6 [9% (14/160) vs. 4% (4/89)]. Positive predictive values for PI-RADS ≥ 3 were similar.

Conclusion

Remote quality assurance of prostate MRI is feasible and useful, enabling new programs to gain durable skills with minimal risk to patients.

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Authors and Affiliations

  1. Department of Radiology, Michigan Medicine, Ann Arbor, MI, USA

    Nicole E. Curci, Prasad R. Shankar & Matthew S. Davenport

  2. Grand Traverse Radiologists PC, Munson Medical Center, Traverse City, MI, USA

    Patrick Gartland

  3. Department of Urology, Michigan Medicine, Ann Arbor, MI, USA

    Jeffrey S. Montgomery, David C. Miller, Arvin K. George & Matthew S. Davenport

  4. Department of Radiology, Michigan Radiology Quality Collaborative, 1500 E. Medical Center Dr. B2-A209P, Ann Arbor, MI, 48108, USA

    Matthew S. Davenport

Authors
  1. Nicole E. Curci
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  2. Patrick Gartland
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Correspondence to Matthew S. Davenport.

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Funding

No extramural funding solicited or used for this work.

Disclosures

Matt Davenport—Royalties from Wolters Kluwer. All other authors—No relevant financial disclosures.

Ethical approval

This prospective longitudinal quality assurance effort was considered to be exempt from oversight by the host institutional review board (IRB). No extramural funding was used. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Curci, N.E., Gartland, P., Shankar, P.R. et al. Long-distance longitudinal prostate MRI quality assurance: from startup to 12 months. Abdom Radiol 43, 2505–2512 (2018). https://doi.org/10.1007/s00261-018-1481-8

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  • DOI: https://doi.org/10.1007/s00261-018-1481-8

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