Standardisation of Prostate Multi Parametric MRI Protocols - Beyond the Abstract

In prostate cancer imaging, multi-parametric (mp) MRI is considered a valuable tool for local disease management and improvement in diagnosis. Recently, the National Institute of Health and Care Excellence (NICE) updated prostate cancer guidelines recommended the adoption of prostate mpMRI in all men with suspected prostate cancer prior to biopsy.

The initial and fundamental step to implement NICE guidelines is the acquisition of diagnostic quality mpMRI images. Since there is no system in place for setting up and performing mpMRI with confirmed diagnostic acceptability; we presented our approach to standardise and affirm the diagnostic quality of prostate mpMRI protocol across 14 hospitals and 21 MR scanners in a region.

Our optimisation consisted of a) an initial assessment of the diagnostic quality of each MR scanner protocol participated in the study, b) the technical implementation/ modification and standardisation of mpMRI protocols and c) the diagnostic quality assessment of final optimised protocols. For the technical implementation, the PIRADS V2 recommendations were followed by a physicist visiting the different hospitals; and for diagnostic quality assessment, experienced radiologists reviewed the pre-optimised and the optimised images based on their ability to “rule in” and “rule out” prostate tumours.

After the optimisation, 20/23 mpMRI protocols, consisting of 111 sequences, were modified. Challenges, mainly related to the clinical daily workload of these MRI departments, obstructed the optimisation process in some cases. However, there was an improvement in the diagnostic quality for the majority of optimised protocols.

Future plans are: firstly to ensure that the proposed changes to the protocols remained and secondly to assess the impact of the optimisation on diagnosis and management of prostate cancer patients. It should be highlighted that for an efficient standardisation of the mpMRI, it is important not only to appropriately optimise the protocols but also to be aware of what diagnostic quality is. Such an approach is feasible when it is organised and set up by appropriate organisations (such as North Central and East London Cancer Alliance) within a region of hospitals.

Written by: Marianthi-Vasiliki Papoutsaki, & Shonit Punwani, Centre for Medical Imaging, University College London, London, UK

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