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The Learning Curve in Bladder MRI Using VI-RADS Assessment Score During an Interactive Dedicated Training Program - Beyond the Abstract

The value of a learning program in oncologic imaging is widely recognized since it provides even younger radiologists to develop an adequate cognitive process to identify various imaging patterns and improves their expertise.1 Bladder MRI is not a common exam, and it requires experience for the detection of lesions and even more for tumour staging by assessing the likelihood of muscle invasiveness, which strongly impacts the overall management and outcome of the patient. For this purpose in 2018, a novel risk assessment scoring system was developed by a panel of experts with the aim of standardizing the protocol of acquisition, image interpretation, and reporting of bladder MRI: the Vesica Imaging-Reporting And Data System score.2 Interestingly, several studies have proved that VI-RADS score, beyond a high diagnostic performance, showed a substantial inter-rater agreement among both experts and inexperienced radiologists.3,4 On the other hand, there are no studies in the literature that have investigated the role of a learning program on the accuracy of BCa staging using VI-RADS score. The aim of the study was to assess the learning curve of radiology residents’ accuracy in interpretation of bladder MRI using VI-RADS score, in the setting of an interactive dedicated training program.

In our study, three radiology residents from two different institutions with minimal experience in bladder MRI interpretation independently evaluated 250 bladder MRI using the VI-RADS score for 3 months, the first 200 cases divided into 4 groups of 50 cases respectively. In the last batch of cases, the first 50 were reinterpreted at the end of the project, to evaluate how the reporting changed after a personalized learning program. Indeed, the image interpretation was integrated with several didactic moments, including lessons on the VIRADS score and on the interpretation of MRI images using it, and hands-on sessions with an expert to discuss equivocal cases.

To achieve the study objectives, the readers were asked to evaluate the different features of BCa (i.e. number of lesions, localization, presence of vascular pedicle, presence of inner layer) and to evaluate the local staging according to the presence or absence of muscle invasiveness, extramural or adjacent organ infiltration, pathologic lymph nodes and bone lesions. Reporting time (including the personal thinking process time-lapse required to pick a score), level of confidence, and quality of the MRI images were also documented as secondary endpoints.

The tested education program on bladder MRI and VI-RADS score was associated with a significant increase in inter-reader agreement over time, particularly when the MRIs were perceived as high-quality images. A general improvement was observed after 100-150 cases, which might be proposed as a cut-off to reach a benchmark in radiology learning programs. This first report reinforces the role of training in imaging and paves the way for new learning methodologies.

Written by: Miguel Correia da Silva, Martina Pecoraro, Martina Lucia Pisciotti, Ailin Dehghanpour, Ali Forookhi, Sara Lucciola, Marco Bicchetti, Emanuele Messina, Carlo Catalano, Valeria Panebianco

Department of Radiology, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal., Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, Rome, Italy., Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, Rome, Italy.

References:

  1. Rosenkrantz AB, Ayoola A, Hoffman D, Khasgiwala A, Prabhu V, Smereka P, et al. The Learning Curve in Prostate MRI Interpretation: Self-Directed Learning Versus Continual Reader Feedback. American Journal of Roentgenology. marzo 2017;208(3):W92–100.
  2. Panebianco V, Narumi Y, Altun E, Bochner BH, Efstathiou JA, Hafeez S, et al. Multiparametric Magnetic Resonance Imaging for Bladder Cancer: Development of VI-RADS (Vesical Imaging-Reporting And Data System). European Urology. settembre 2018;74(3):294–306.
  3. Metwally MI, Zeed NA, Hamed EM, Elshetry ASF, Elfwakhry RM, Alaa Eldin AM, et al. The validity, reliability, and reviewer acceptance of VI-RADS in assessing muscle invasion by bladder cancer: a multicenter prospective study. Eur Radiol. settembre 2021;31(9):6949–61.
  4. Del Giudice FD, Pecoraro M, Vargas HA, Cipollari S, De Berardinis E, Bicchetti M, et al. Systematic Review and Meta-Analysis of Vesical Imaging-Reporting and Data System (VI-RADS) Inter-Observer Reliability: An Added Value for Muscle Invasive Bladder Cancer Detection. Cancers. 15 ottobre 2020;12(10):2994.

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