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

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

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.

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.

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

Abdominal radiology (New York). 2018 Feb 22 [Epub ahead of print]

Nicole E Curci, Patrick Gartland, Prasad R Shankar, Jeffrey S Montgomery, David C Miller, Arvin K George, Matthew S Davenport

Department of Radiology, Michigan Medicine, Ann Arbor, MI, USA., Grand Traverse Radiologists PC, Munson Medical Center, Traverse City, MI, USA., Department of Urology, Michigan Medicine, Ann Arbor, MI, USA., Department of Radiology, Michigan Medicine, Ann Arbor, MI, USA. .