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Optimization of non-endorectal prostate MR image quality using PI-QUAL: A multidisciplinary team approach.

Publication ,  Journal Article
Robertson, SH; Owenby, E; Beasley, C; Wall, L; Gray, B; Boru, I; Kalisz, KR; Kruse, DE; Marin, D; Thomas, SP; Macdonald, EB; Purysko, AS; Gupta, RT
Published in: Eur J Radiol
September 2023

PURPOSE: To evaluate the utility of the PI-QUAL score in assessing protocol changes aimed to improve image quality from a non-endorectal coil prostate MR imaging protocol during a 9-month quality improvement (QI) project and to quantify the inter-reader agreement of PI-QUAL scores between radiologists, technologists, and physicists. METHODS: This retrospective study audited 1,012 multiparametric prostate MRI examinations as part of a national QI project according to the PI-QUAL standard. PI-QUAL scores were used to inform MR protocol changes. Following the project, 4 radiologists, 2 technologists, and 1 medical physicist collectively audited an additional set of 150 examinations to identify statistical improvements in image quality using the two-tailed Wilcoxon rank sum test. The improvements due to individual protocol changes were assessed among subsets of the 1,012 examinations which compared examinations occurring before and after the isolated protocol change. Inter-reader variability was assessed using the percent majority agreement and the average standard deviation of PI-QUAL scores between evaluators. RESULTS: During this QI project, PI-QUAL scores improved from 3.67 ± 0.75 to 4.16 ± 0.59 (p < 0.01) after implementing a series of protocol changes. Among a subset of 451 cases, we found that adopting R/L rather than A/P phase encoding reduced distortion in diffusion-weighted imaging (DW) from 21.6% (41/190 A/P phase encoded cases) to 11.5% (30/261 R/L phase encoded cases) (p < 0.01). Similarly, in the same 451 cases, adopting R/L phase encoding in T2WI reduced breathing motion artifacts from 34.6% (94/272 A/P phase encoding cases) to 12.8% (23/179 R/L phase encoding cases) (p < 0.01). DWI wraparound artifact was mitigated by employing a full-pelvis shim and enabling the abdomen shim option. The occurrence of low signal-to-noise ratio was reduced from 19.4% (19/98 cases without a weight-based threshold) to 6.3% (10/160) by instituting a weight-based threshold for using an endorectal coil (p < 0.01). The percent majority agreement was similar between radiologists, technologists and physicists, and all evaluators combined (72%, 77%, and 67%, respectively). CONCLUSIONS: PI-QUAL can evaluate image quality changes resulting from protocol optimizations at both the exam- and series-levels. With training, radiologists, technologists, and physicists can perform PI-QUAL scoring with similar performance. Broadening the scope of the quality improvement team can result in meaningful and lasting change.

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Published In

Eur J Radiol

DOI

EISSN

1872-7727

Publication Date

September 2023

Volume

166

Start / End Page

110998

Location

Ireland

Related Subject Headings

  • Retrospective Studies
  • Prostatic Neoplasms
  • Prostate
  • Pelvis
  • Patient Care Team
  • Nuclear Medicine & Medical Imaging
  • Male
  • Magnetic Resonance Imaging
  • Humans
  • Diffusion Magnetic Resonance Imaging
 

Citation

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Robertson, S. H., Owenby, E., Beasley, C., Wall, L., Gray, B., Boru, I., … Gupta, R. T. (2023). Optimization of non-endorectal prostate MR image quality using PI-QUAL: A multidisciplinary team approach. Eur J Radiol, 166, 110998. https://doi.org/10.1016/j.ejrad.2023.110998
Robertson, Scott H., Erica Owenby, Christopher Beasley, Lisa Wall, Bradley Gray, Issack Boru, Kevin R. Kalisz, et al. “Optimization of non-endorectal prostate MR image quality using PI-QUAL: A multidisciplinary team approach.Eur J Radiol 166 (September 2023): 110998. https://doi.org/10.1016/j.ejrad.2023.110998.
Robertson SH, Owenby E, Beasley C, Wall L, Gray B, Boru I, et al. Optimization of non-endorectal prostate MR image quality using PI-QUAL: A multidisciplinary team approach. Eur J Radiol. 2023 Sep;166:110998.
Robertson, Scott H., et al. “Optimization of non-endorectal prostate MR image quality using PI-QUAL: A multidisciplinary team approach.Eur J Radiol, vol. 166, Sept. 2023, p. 110998. Pubmed, doi:10.1016/j.ejrad.2023.110998.
Robertson SH, Owenby E, Beasley C, Wall L, Gray B, Boru I, Kalisz KR, Kruse DE, Marin D, Thomas SP, Macdonald EB, Purysko AS, Gupta RT. Optimization of non-endorectal prostate MR image quality using PI-QUAL: A multidisciplinary team approach. Eur J Radiol. 2023 Sep;166:110998.
Journal cover image

Published In

Eur J Radiol

DOI

EISSN

1872-7727

Publication Date

September 2023

Volume

166

Start / End Page

110998

Location

Ireland

Related Subject Headings

  • Retrospective Studies
  • Prostatic Neoplasms
  • Prostate
  • Pelvis
  • Patient Care Team
  • Nuclear Medicine & Medical Imaging
  • Male
  • Magnetic Resonance Imaging
  • Humans
  • Diffusion Magnetic Resonance Imaging