How are we going to train a generation of radiologists (and urologists) to read prostate MRI?

Abstract

PURPOSE OF REVIEW Multiparametric MRI has gained tremendous importance in the daily practice for patients at risk or diagnosed with prostate cancer. Interpretation of multiparametric-MRI is a complex task, supposedly restricted to experienced radiologists. The purpose of this review is to analyze fundamentals of multiparametric-MRI interpretation and to describe how multiparametric-MRI training could be organized. RECENT FINDINGS Recently, professional guidelines have been published to provide technical and interpretation frameworks and harmonize multiparametric-MRI practice, but the question of physicians training in prostate multiparametric-MRI reading is still pending. What kind of education, practice, and training makes a radiologist able to reliably interpret a prostate multiparametric-MRI? How can findings be reported to be easily understood? How much experience is needed? How can we train urologists and other physicians to review the examinations they request? Is double-reading necessary? SUMMARY An institutional-based competency certification process for prostate multiparametric-MRI interpretation may encourage nonspecialized radiologists to qualify for prostate imaging in a standardized and reproducible way, exactly as urologists need it. Purpose of review Multiparametric MRI has gained tremendous importance in the daily practice for patients at risk or diagnosed with prostate cancer. Interpretation of multiparametric-MRI is a complex task, supposedly restricted to experienced radiologists. The purpose of this review is to analyze fundamentals of multiparametric-MRI interpretation and to describe how multiparametric-MRI training could be organized. Recent findingsRecently, professional guidelines have been published to provide technical and interpretation frameworks and harmonize multiparametric-MRI practice, but the question of physicians training in prostate multiparametric-MRI reading is still pending. What kind of education, practice, and training makes a radiologist able to reliably interpret a prostate multiparametric-MRI? How can findings be reported to be easily understood? How much experience is needed? How can we train urologists and other physicians to review the examinations they request? Is double-reading necessary? Summary An institutional-based competency certification process for prostate multiparametric-MRI interpretation may encourage nonspecialized radiologists to qualify for prostate imaging in a standardized and reproducible way, exactly as urologists need it.

Current Utilization and Acceptance of Multiparametric MRI in the Diagnosis of Prostate Cancer. A Regional Survey

“…More than one-third of the physicians saw indications of MRI which went beyond the recommendations of the current S3 guideline and were thus oriented more toward international guidelines [14 -16]. However, attending physicians must be provided with a deeper understanding of MRI findings in order to make full use of the diagnostic potential of prostate MRI and to make the method overall more cost-effective [18,27]. The 2015 survey of German physicians criticized inadequate feedback from attending physicians to radiologists after prostate MRI [17].…”

Comparison of initial and tertiary centre second opinion reads of multiparametric magnetic resonance imaging of the prostate prior to repeat biopsy

“…Aside from increasing the number of central subspecialised radiologists, another option may be to provide more training to radiologists at the outside hospitals. A suggested way to achieve this is the adoption of a temporary intermediate competency certification process based on the experience of 50–100 cases with a supervised systematic double-reading by an experienced reader and pathology feedback [15, 16]. …”

“…One reason for inaccurate detection of significant cancer in mpMRI could be that mpMRI interpretation accuracy highly depends on the experience of the reader [8–14]. Currently, it is estimated that 100 mpMRI reports supervised by a systematic double-reader and validated by histopathology are needed to gain sufficient reader competence [15], and subsequently at least 50 mpMRIs per year are required to maintain experience levels [16]. Whilst PI-RADS version 1 focused mainly on minimal and optimal MRI protocol standards, the more recently updated PI-RADS version 2 concentrates on standardisation of reading, highlighting a perceived problem [17, 18].…”

Risk stratification of prostate cancer utilizing apparent diffusion coefficient value and lesion volume on multiparametric MRI

“…Although current recommendations support the use of consensus reads when starting an imaging program, we continued our consensus reads as part of our normal workflow. Radiology–pathology correlation and imaging quality review allowed for ongoing improvements and collaborations between all departments . In addition, two biopsy cores (one each in the axial and sagittal planes) were obtained from each lesion, an approach shown to improve cancer detection by about 8% .…”

“…Radiology-pathology correlation and imaging quality review allowed for ongoing improvements and collaborations between all departments. 31 In addition, two biopsy cores (one each in the axial and sagittal planes) were obtained from each lesion, an approach shown to improve cancer detection by about 8%. 18 Third, we do not have radical prostatectomy specimens to determine the true positivity rate of suspicious lesions on mpMRI, hence theoretically some lesions may have been misclassified.…”