1
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Spilseth B, Giganti F, Chang SD. The importance and future of prostate MRI report templates: improving oncological care. Abdom Radiol (NY) 2024; 49:2770-2781. [PMID: 38900327 DOI: 10.1007/s00261-024-04434-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/30/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024]
Abstract
The radiologist's report is crucial for guiding care post-imaging, with ongoing advancements in report construction. Recent studies across various modalities and organ systems demonstrate enhanced clarity and communication through structured reports. This article will explain the benefits of disease-state specific reporting templates using prostate MRI as the model system. We identify key reporting components for prostate cancer detection and staging as well as imaging in active surveillance and following therapy. We discuss relevant reporting systems including PI-QUAL, PI-RADS, PRECISE, PI-RR and PI-FAB systems. Additionally, we examine optimal reporting structure including disruptive technologies such as graphical reporting and using artificial intelligence to improve report clarity and applicability.
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Affiliation(s)
- Benjamin Spilseth
- Department of Radiology, University of Minnesota Medical School, Minneapolos, Minnesota, USA
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Silvia D Chang
- Department of Radiology, University of British Columbia Vancouver General Hospital, 899 West 12th Avenue, Vancouver, B.C, V5Z 1M9, Canada.
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2
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Miszewski K, Skrobisz K, Miszewska L, Matuszewski M. Interpreting Prostate MRI Reports in the Era of Increasing Prostate MRI Utilization: A Urologist's Perspective. Diagnostics (Basel) 2024; 14:1060. [PMID: 38786358 PMCID: PMC11120165 DOI: 10.3390/diagnostics14101060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/16/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
Multi-parametric prostate MRI (mpMRI) is crucial for diagnosing, staging, and assessing treatment response in individuals with prostate cancer. Radiologists, through an accurate and standardized interpretation of mpMRI, stratify patients who may benefit from more invasive treatment or exclude patients who may be harmed by overtreatment. The integration of prostate MRI into the diagnostic pathway is anticipated to generate a substantial surge in the demand for high-quality mpMRI, estimated at approximately two million additional prostate MRI scans annually in Europe. In this review we examine the immediate impact on healthcare, particularly focusing on the workload and evolving roles of radiologists and urologists tasked with the interpretation of these reports and consequential decisions regarding prostate biopsies. We investigate important questions that influence how prostate MRI reports are handled. The discussion aims to provide insights into the collaboration needed for effective reporting.
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Affiliation(s)
- Kevin Miszewski
- Department of Urology, Gdańsk Medical University, Mariana Smoluchowskiego 17 Street, 80-214 Gdańsk, Poland
| | - Katarzyna Skrobisz
- Department of Radiology, Gdańsk Medical University, Mariana Smoluchowskiego 17 Street, 80-214 Gdańsk, Poland
| | - Laura Miszewska
- Student Scientific Association, Gdańsk Medical University, Mariana Smoluchowskiego 17 Street, 80-214 Gdańsk, Poland
| | - Marcin Matuszewski
- Department of Urology, Gdańsk Medical University, Mariana Smoluchowskiego 17 Street, 80-214 Gdańsk, Poland
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3
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Alami Idrissi Y, Virador GM, Singh RB, Rao D, Stone JA, Sandhu SJS. Imaging 3.0: A scoping review. Curr Probl Diagn Radiol 2024; 53:399-404. [PMID: 38242771 DOI: 10.1067/j.cpradiol.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/16/2024] [Indexed: 01/21/2024]
Abstract
We aim to provide a comprehensive summary of the current body of literature concerning the Imaging 3.0 initiative and its implications for patient care within the field of radiology. We offer a thorough analysis of the literature pertaining to the Imaging 3.0 initiative, emphasizing the practical application of the five pillars of the program, their cost-effectiveness, and their benefits in patient management. By doing so, we hope to illustrate the impact the Imaging 3.0 Initiative can have on the future of radiology and patient care.
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Affiliation(s)
- Yassine Alami Idrissi
- Hillman Cancer Center, University of Pittsburgh Medical Center, 5030 Centre avenue, Pittsburgh, PA 15213, United States.
| | - Gabriel M Virador
- Department of Internal Medicine, Medstar Union Memorial Hospital, Baltimore, MD, United States
| | - Rahul B Singh
- Department of Internal Medicine, New York City Health and Hospitals/South Brooklyn Health, Brooklyn, NY, United States
| | - Dinesh Rao
- Department of Radiology, Mayo Clinic, Jacksonville, FL, United States
| | - Jeffrey A Stone
- Department of Radiology, Mayo Clinic, Jacksonville, FL, United States
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4
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Krausewitz P, Borkowetz A, Ortner G, Kornienko K, Wenzel M, Westhoff N. Do we need MRI in all biopsy naïve patients? A multicenter cohort analysis. World J Urol 2024; 42:73. [PMID: 38324090 PMCID: PMC10850200 DOI: 10.1007/s00345-024-04780-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/09/2024] [Indexed: 02/08/2024] Open
Abstract
PURPOSE The combined approach (CB) of magnetic resonance imaging (MRI)-guided biopsy (TB) and systematic biopsy (SB) is strongly recommended based on numerous studies in biopsy naïve men with suspicion of clinically significant prostate cancer (csPCA). However, the unbalanced accessibility of MRI, challenges related to reimbursement and the scarcity of specialized medical practitioners continue to impede a widespread implementation. Therefore, our objective was to determine a subset of men that could undergo SB without an increased risk of underdiagnosis at reduced expenses. METHODS A multicenter analysis of 2714 men with confirmed PCA and suspicious MRI who underwent CB were enrolled. Cancer detection rates were compared between the different biopsy routes SB, TB and CB using McNemar paired test. Additionally, Gleason grade up- and down-grading was determined. RESULTS CB detected more csPCA than TB and SB (p < 0.001), irrespective of MRI findings or biopsy route (transperineal vs. transrectal). Thereby, single biopsy approaches misgraded > 50% of csPCA. TB showed higher diagnostic efficiency, defined as csPCA detection per biopsy core than CB and SB (p < 0.001). For patients with abnormal DRE and PSA levels > 12.5 ng/ml, PSAD > 0.35 ng/ml/cm3, or > 75 years, SB and CB showed similar csPCA detection rates. CONCLUSION Conducting CB provides the highest level of diagnostic certainty and minimizes the risk of underdiagnosis in almost all biopsy-naive men. However, in patients with suspicious DRE and high PSA levels, PSAD, or advanced age solely using SB leads to similar csPCA detection rates. Thus, a reduced biopsy protocol may be considered for these men in case resources are limited.
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Affiliation(s)
- Philipp Krausewitz
- Department of Urology and Pediatric Urology, University Medical Center Bonn (UKB), University Hospital Bonn, Bonn, Germany.
| | - Angelika Borkowetz
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Gernot Ortner
- Department of Urology, LKH Hall, Hall in Tirol, Austria
| | - Kira Kornienko
- Department of Urology, Charité University Medicine Berlin, Berlin, Germany
| | - Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Niklas Westhoff
- Department of Urology and Urological Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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5
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Spilseth B, Margolis DJA, Gupta RT, Chang SD. Interpretation of Prostate Magnetic Resonance Imaging Using Prostate Imaging and Data Reporting System Version 2.1: A Primer. Radiol Clin North Am 2024; 62:17-36. [PMID: 37973241 DOI: 10.1016/j.rcl.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Prostate magnetic resonance imaging (MRI) is increasingly being used to diagnose and stage prostate cancer. The Prostate Imaging and Data Reporting System (PI-RADS) version 2.1 is a consensus-based reporting system that provides a standardized and reproducible method for interpreting prostate MRI. This primer provides an overview of the PI-RADS system, focusing on its current role in clinical interpretation. It discusses the appropriate use of PI-RADS and how it should be applied by radiologists in clinical practice to assign and report PI-RADS assessments. We also discuss the changes from prior versions and published validation studies on PI-RADS accuracy and reproducibility.
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Affiliation(s)
- Benjamin Spilseth
- Department of Radiology, University of Minnesota Medical School, MMC 292420, Delaware Street, Minneapolis, MN 55455, USA.
| | - Daniel J A Margolis
- Weill Cornell Medical College, Department of Radiology, 525 East 68th Street, Box 141, New York, NY 10068, USA
| | - Rajan T Gupta
- Department of Radiology, Duke University Medical Center, Duke Cancer Institute Center for Prostate & Urologic Cancers, DUMC Box 3808, Durham, NC 27710, USA; Department of Surgery, Duke University Medical Center, Duke Cancer Institute Center for Prostate & Urologic Cancers, DUMC Box 3808, Durham, NC 27710, USA
| | - Silvia D Chang
- Department of Radiology, University of British Columbia, Vancouver General Hospital, 899 West 12th Avenue, Vancouver B.C., Canada V5M 1M9
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6
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Inoue T, Shin T. Current magnetic resonance imaging-based diagnostic strategies for prostate cancer. Int J Urol 2023; 30:1078-1086. [PMID: 37592819 DOI: 10.1111/iju.15281] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/02/2023] [Indexed: 08/19/2023]
Abstract
Recent developments in multiparametric MRI and MRI-targeted biopsy have made it possible to detect clinically significant cancers more accurately and efficiently than ever before. Furthermore, software that enables easy MRI/US image fusion has been developed and is already available on the market, and this has provided a tailwind for the spread of MRI-based prostate cancer diagnostic strategies. Such precise diagnosis of prostate cancer localization is essential for highly accurate focal therapy. In addition, a recent large-scale study applying MRI to community screening for prostate cancer has reported its usefulness. By contrast, concerns about overdiagnosis and overtreatment, the existence of inter-reader variability in MRI diagnosis, and issues with current MRI-targeted biopsy have emerged. In this article, we review the development of multiparametric MRI and MRI-targeted biopsy to date and the current issues and discuss future directions.
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Affiliation(s)
- Toru Inoue
- Department of Urology, Oita University Faculty of Medicine, Oita, Japan
| | - Toshitaka Shin
- Department of Urology, Oita University Faculty of Medicine, Oita, Japan
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7
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Kim CK. [Prostate Imaging Reporting and Data System (PI-RADS) v 2.1: Overview and Critical Points]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:75-91. [PMID: 36818694 PMCID: PMC9935951 DOI: 10.3348/jksr.2022.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/15/2023] [Accepted: 01/20/2023] [Indexed: 02/09/2023]
Abstract
The technical parameters and imaging interpretation criteria of the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) using multiparametric MRI (mpMRI) are updated in PI-RADS v2.1. These changes have been an expected improvement for prostate cancer evaluation, although some issues remain unsolved, and new issues have been raised. In this review, a brief overview of PI-RADS v2.1 is and several critical points are discussed as follows: the need for more detailed protocols of mpMRI, lack of validation of the revised transition zone interpretation criteria, the need for clarification for the revised diffusion-weighted imaging and dynamic contrast-enhanced imaging criteria, anterior fibromuscular stroma and central zone assessment, assessment of background signal and tumor aggressiveness, changes in the structured report, the need for the parameters for imaging quality and performance control, and indications for expansion of the system to include other indications.
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Affiliation(s)
- Chan Kyo Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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8
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Barrett T, de Rooij M, Giganti F, Allen C, Barentsz JO, Padhani AR. Quality checkpoints in the MRI-directed prostate cancer diagnostic pathway. Nat Rev Urol 2023; 20:9-22. [PMID: 36168056 DOI: 10.1038/s41585-022-00648-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 01/11/2023]
Abstract
Multiparametric MRI of the prostate is now recommended as the initial diagnostic test for men presenting with suspected prostate cancer, with a negative MRI enabling safe avoidance of biopsy and a positive result enabling MRI-directed sampling of lesions. The diagnostic pathway consists of several steps, from initial patient presentation and preparation to performing and interpreting MRI, communicating the imaging findings, outlining the prostate and intra-prostatic target lesions, performing the biopsy and assessing the cores. Each component of this pathway requires experienced clinicians, optimized equipment, good inter-disciplinary communication between specialists, and standardized workflows in order to achieve the expected outcomes. Assessment of quality and mitigation measures are essential for the success of the MRI-directed prostate cancer diagnostic pathway. Quality assurance processes including Prostate Imaging-Reporting and Data System, template biopsy, and pathology guidelines help to minimize variation and ensure optimization of the diagnostic pathway. Quality control systems including the Prostate Imaging Quality scoring system, patient-level outcomes (such as Prostate Imaging-Reporting and Data System MRI score assignment and cancer detection rates), multidisciplinary meeting review and audits might also be used to provide consistency of outcomes and ensure that all the benefits of the MRI-directed pathway are achieved.
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Affiliation(s)
- Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
| | - Maarten de Rooij
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Jelle O Barentsz
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Middlesex, UK
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9
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Fowler KJ, Bashir MR, Fetzer DT, Kitao A, Lee JM, Jiang H, Kielar AZ, Ronot M, Kamaya A, Marks RM, Elsayes KM, Tang A, Sirlin CB, Chernyak V. Universal Liver Imaging Lexicon: Imaging Atlas for Research and Clinical Practice. Radiographics 2023; 43:e220066. [PMID: 36427260 DOI: 10.1148/rg.220066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The use of standardized terms in assessing and reporting disease processes has well-established benefits, such as clear communication between radiologists and other health care providers, improved diagnostic accuracy and reproducibility, and the enhancement and facilitation of research. Recently, the Liver Imaging Reporting and Data System (LI-RADS) Steering Committee released a universal liver imaging lexicon. The current version of the lexicon includes 81 vetted and precisely defined terms that are relevant to acquisition of images using all major liver imaging modalities and contrast agents, as well as lesion- and organ-level features. Most terms in the lexicon are applicable to all patients undergoing imaging of the liver, and only a minority of the terms are strictly intended to be used for patients with high risk factors for hepatocellular carcinoma. This pictorial atlas familiarizes readers with the liver imaging lexicon and includes discussion of general concepts, providing sample definitions, schematics, and clinical examples for a subset of the terms in the liver imaging lexicon. The authors discuss general, technical, and imaging feature terms used commonly in liver imaging, with the goal of illustrating their use for clinical and research applications. Work of the U.S. Government published under an exclusive license with the RSNA. Online supplemental material is available for this article.
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Affiliation(s)
- Kathryn J Fowler
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Mustafa R Bashir
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - David T Fetzer
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Azusa Kitao
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Jeong Min Lee
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Hanyu Jiang
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Ania Z Kielar
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Maxime Ronot
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Aya Kamaya
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Robert M Marks
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Khaled M Elsayes
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - An Tang
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Claude B Sirlin
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Victoria Chernyak
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
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10
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Zhang D, Neely B, Lo JY, Patel BN, Hyslop T, Gupta RT. Utility of a Rule-Based Algorithm in the Assessment of Standardized Reporting in PI-RADS. Acad Radiol 2022; 30:1141-1147. [PMID: 35909050 DOI: 10.1016/j.acra.2022.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/15/2022] [Accepted: 06/28/2022] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES Adoption of the Prostate Imaging Reporting & Data System (PI-RADS) has been shown to increase detection of clinically significant prostate cancer on prostate mpMRI. We propose that a rule-based algorithm based on Regular Expression (RegEx) matching can be used to automatically categorize prostate mpMRI reports into categories as a means by which to assess for opportunities for quality improvement. MATERIALS AND METHODS All prostate mpMRIs performed in the Duke University Health System from January 2, 2015, to January 29, 2021, were analyzed. Exclusion criteria were applied, for a total of 5343 male patients and 6264 prostate mpMRI reports. These reports were then analyzed by our RegEx algorithm to be categorized as PI-RADS 1 through PI-RADS 5, Recurrent Disease, or "No Information Available." A stratified, random sample of 502 mpMRI reports was reviewed by a blinded clinical team to assess performance of the RegEx algorithm. RESULTS Compared to manual review, the RegEx algorithm achieved overall accuracy of 92.6%, average precision of 88.8%, average recall of 85.6%, and F1 score of 0.871. The clinical team also reviewed 344 cases that were classified as "No Information Available," and found that in 150 instances, no numerical PI-RADS score for any lesion was included in the impression section of the mpMRI report. CONCLUSION Rule-based processing is an accurate method for the large-scale, automated extraction of PI-RADS scores from the text of radiology reports. These natural language processing approaches can be used for future initiatives in quality improvement in prostate mpMRI reporting with PI-RADS.
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Nobel JM, van Geel K, Robben SGF. Structured reporting in radiology: a systematic review to explore its potential. Eur Radiol 2022; 32:2837-2854. [PMID: 34652520 PMCID: PMC8921035 DOI: 10.1007/s00330-021-08327-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/15/2021] [Accepted: 09/13/2021] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Structured reporting (SR) in radiology reporting is suggested to be a promising tool in clinical practice. In order to implement such an emerging innovation, it is necessary to verify that radiology reporting can benefit from SR. Therefore, the purpose of this systematic review is to explore the level of evidence of structured reporting in radiology. Additionally, this review provides an overview on the current status of SR in radiology. METHODS A narrative systematic review was conducted, searching PubMed, Embase, and the Cochrane Library using the syntax 'radiol*' AND 'structur*' AND 'report*'. Structured reporting was divided in SR level 1, structured layout (use of templates and checklists), and SR level 2, structured content (a drop-down menu, point-and-click or clickable decision trees). Two reviewers screened the search results and included all quantitative experimental studies that discussed SR in radiology. A thematic analysis was performed to appraise the evidence level. RESULTS The search resulted in 63 relevant full text articles out of a total of 8561 articles. Thematic analysis resulted in 44 SR level 1 and 19 level 2 reports. Only one paper was scored as highest level of evidence, which concerned a double cohort study with randomized trial design. CONCLUSION The level of evidence for implementing SR in radiology is still low and outcomes should be interpreted with caution. KEY POINTS • Structured reporting is increasingly being used in radiology, especially in abdominal and neuroradiological CT and MRI reports. • SR can be subdivided into structured layout (SR level 1) and structured content (SR level 2), in which the first is defined as being a template in which the reporter has to report; the latter is an IT-based manner in which the content of the radiology report can be inserted and displayed into the report. • Despite the extensive amount of research on the subject of structured reporting, the level of evidence is low.
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Affiliation(s)
- J Martijn Nobel
- Department of Radiology, Maastricht University Medical Center+, Postbox 5800, 6202 AZ, Maastricht, the Netherlands.
- Department of Educational Development and Research and School of Health Professions Education, Maastricht University, Maastricht, the Netherlands.
| | - Koos van Geel
- Department of Educational Development and Research and School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
- Department of Medical Imaging of Zuyderland Medical Center, Heerlen, the Netherlands
| | - Simon G F Robben
- Department of Radiology, Maastricht University Medical Center+, Postbox 5800, 6202 AZ, Maastricht, the Netherlands
- Department of Educational Development and Research and School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
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12
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Wang L, Margolis DJ, Chen M, Zhao X, Li Q, Yang Z, Tian J, Wang Z. Quality in MR reporting of the prostate – improving acquisition, the role of AI and future perspectives. Br J Radiol 2022; 95:20210816. [PMID: 35119914 PMCID: PMC8978223 DOI: 10.1259/bjr.20210816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The high quality of MRI reporting of the prostate is the most critical component of the service provided by a radiologist. Prostate MRI structured reporting with PI-RADS v. 2.1 has been proven to improve consistency, quality, guideline-based care in the management of prostate cancer. There is room for improved accuracy of prostate mpMRI reporting, particularly as PI-RADS core criteria are subjective for radiologists. The application of artificial intelligence may support radiologists in interpreting MRI scans. This review addresses the quality of prostate multiparametric MRI (mpMRI) structured reporting (include improvements in acquisition using artificial intelligence) in terms of size of prostate gland, imaging quality, lesion location, lesion size, TNM staging, sector map, and discusses the future prospects of quality in MR reporting.
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Affiliation(s)
- Liang Wang
- Department of Radiology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Daniel J. Margolis
- Department of Radiology, Weill Cornell Medicine/ New York Presbyterian, New York, United States
| | - Min Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xinming Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiubai Li
- Department of Radiology, University of Iowa, Roy Carver College of Medicine, Iowa, United States
| | - Zhenghan Yang
- Department of Radiology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | | | - Zhenchang Wang
- Department of Radiology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
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13
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Dick H, Doth S, Ernst C, Fischer S, Holderried M. [Current developments on digitalization : Analysis of quality and economics in healthcare]. Urologe A 2021; 60:1141-1149. [PMID: 34347134 PMCID: PMC8335973 DOI: 10.1007/s00120-021-01606-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 11/29/2022]
Abstract
Hintergrund Im deutschen Gesundheitssystem und damit auch im Fachgebiet der Urologie gewinnen ökonomische Rahmenbedingungen zunehmend an Bedeutung und parallel dazu werden digitale Anwendungen vermehrt eingesetzt. Fragestellung Die Fragestellung betrifft die gesundheitsökonomische Auseinandersetzung mit den Rahmenbedingungen der Digitalisierung im deutschen Gesundheitssystem sowie ausgewählter Anwendungsbereiche in der Urologie. Material und Methoden Das Gutachten des Sachverständigenrates zur Begutachtung der Entwicklung im Gesundheitswesen (SVR) wird analysiert und eine systematische Literaturanalyse zum Einsatz der strukturierten Befundung und Analyse ausgewählter Literatur zu telemedizinischen Anwendungen in der Urologie unter gesundheitsökonomischen Gesichtspunkten durchgeführt. Ergebnisse Als zentrale Hemmnisse bei der Digitalisierung des deutschen Gesundheitswesens identifiziert der SVR dessen Regulierung und Komplexität sowie den Umgang mit Datenschutz und -sicherheit. Der Einsatz strukturierter Befundung kann Qualität, Effektivität und Effizienz der Befundung in der Urologie steigern. Im Hinblick auf die Kosten können signifikante Einsparungen mit zunehmender Digitalisierung in der Medizin realisiert werden. Schlussfolgerungen Aus medizinischer und gesundheitsökonomischer Perspektive besteht bei der Ausgestaltung von Rahmenbedingungen für digitale Anwendungen im deutschen Gesundheitssystem hinsichtlich der Informationssicherheit und des Datenschutzes weiterer Gestaltungsbedarf. Bei zielgerichtetem Einsatz von digitalen Anwendungen wie der strukturierten Befundung und der Telemedizin können optimale Voraussetzungen für den zunehmenden Einsatz von künstlicher Intelligenz im Fachgebiet der Urologie geschaffen werden.
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Affiliation(s)
- H Dick
- Institut Health Care & Public Management, Lehrstuhl für Ökonomik und Management sozialer Dienstleistungen (530B), Universität Hohenheim, Fruwirthstraße 48, 70599, Stuttgart, Deutschland
| | - S Doth
- Institut Health Care & Public Management, Lehrstuhl für Ökonomik und Management sozialer Dienstleistungen (530B), Universität Hohenheim, Fruwirthstraße 48, 70599, Stuttgart, Deutschland
| | - C Ernst
- Institut Health Care & Public Management, Lehrstuhl für Ökonomik und Management sozialer Dienstleistungen (530B), Universität Hohenheim, Fruwirthstraße 48, 70599, Stuttgart, Deutschland.
| | - S Fischer
- Institut Health Care & Public Management, Lehrstuhl für Ökonomik und Management sozialer Dienstleistungen (530B), Universität Hohenheim, Fruwirthstraße 48, 70599, Stuttgart, Deutschland
| | - M Holderried
- Institut Health Care & Public Management, Lehrstuhl für Ökonomik und Management sozialer Dienstleistungen (530B), Universität Hohenheim, Fruwirthstraße 48, 70599, Stuttgart, Deutschland.,Zentralbereich Medizin: Struktur‑, Prozess- und Qualitätsmanagement, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 6, 72076, Tübingen, Deutschland
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Stanzione A, Boccadifuoco F, Cuocolo R, Romeo V, Mainenti PP, Brunetti A, Maurea S. State of the art in abdominal MRI structured reporting: a review. Abdom Radiol (NY) 2021; 46:1218-1228. [PMID: 32936418 PMCID: PMC7940284 DOI: 10.1007/s00261-020-02744-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/27/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022]
Abstract
In the management of several abdominal disorders, magnetic resonance imaging (MRI) has the potential to significantly improve patient's outcome due to its diagnostic accuracy leading to more appropriate treatment choice. However, its clinical value heavily relies on the quality and quantity of diagnostic information that radiologists manage to convey through their reports. To solve issues such as ambiguity and lack of comprehensiveness that can occur with conventional narrative reports, the adoption of structured reporting has been proposed. Using a checklist and standardized lexicon, structured reports are designed to increase clarity while assuring that all key imaging findings related to a specific disorder are included. Unfortunately, structured reports have their limitations too, such as risk of undue report simplification and poor template plasticity. Their adoption is also far from widespread, and probably the ideal balance between radiologist autonomy and report consistency of has yet to be found. In this article, we aimed to provide an overview of structured reporting proposals for abdominal MRI and of works assessing its value in comparison to conventional free-text reporting. While for several abdominal disorders there are structured templates that have been endorsed by scientific societies and their adoption might be beneficial, stronger evidence confirming their imperativeness and added value in terms of clinical practice is needed, especially regarding the improvement of patient outcome.
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Affiliation(s)
- Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Francesca Boccadifuoco
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Renato Cuocolo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy.
| | - Valeria Romeo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Pier Paolo Mainenti
- Institute of Biostructures and Bioimaging, National Research Council, Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Simone Maurea
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
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15
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Bertolo R, Vittori M, Cipriani C, Maiorino F, Forte V, Iacovelli V, Petta F, Sperandio M, Marani C, Panei M, Travaglia S, Bove P. Diagnostic pathway of the biopsy-naïve patient suspected for prostate cancer: Real-life scenario when multiparametric Magnetic Resonance Imaging is not centralized. Prog Urol 2021; 31:739-746. [PMID: 33431200 DOI: 10.1016/j.purol.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/27/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION We aimed to compare the pathway including multi-parametric Magnetic Resonance Imaging (mpMRI) versus the one without mpMRI in detection of prostate cancer (PCa) when mpMRI is not centralized. MATERIALS January 2019-March 2020: prospective data collection of trans-perineal prostate biopsies. Group A: biopsy-naïve patients who underwent mpMRI (at any institution) versus Group B: patients who did not. Within Group A, patients were stratified into those with negative mpMRI (mpMRI-, PIRADS v2.1=1-3, with PSA density <0.15 if PIRADS 3) who underwent standard biopsy (SB), versus those with positive mpMRI (mpMRI+, when PIRADS 3-5, with PSA density>0.15 if PIRADS 3) who underwent cognitive fusion biopsy. RESULTS Two hundred and eighty one biopsies were analyzed. 153 patients underwent mpMRI (Group A). 98 mpMRI+ underwent fusion biopsy; 55 mpMRI- underwent SB. 128 Group B patients underwent SB. Overall PCa detection rate was 52.3% vs. 48.4% (Group A vs. B, P=0.5). Non-clinically-significant PCa was detected in 7.8 vs. 13.3% (Group A vs. B, P=0.1). Among the 98 mpMRI+ Group A patients only 2 had non clinically-significant disease. In 55 mpMRI- patients who underwent SB, 10 (18.2%) had clinically-significant PCa. Prostate volume predicted detection of PCa. In Group B, age and PSA predicted PCa. Sensitivity of mpMRI was 75.0% for all PCa, 85.3% for clinically-significant PCa. CONCLUSION Higher detection of PCa and lower detection of non-clinically-significant PCa favored mpMRI pathway. A consistent number of clinically-significant PCa was diagnosed after a mpMRI-. Thus, in real-life scenario, mpMRI- does not obviate indication to biopsy when mpMRI is not centralized. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- R Bertolo
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy.
| | - M Vittori
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - C Cipriani
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - F Maiorino
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - V Forte
- Department of Radiology, San Carlo di Nancy Hospital, Rome, Italy
| | - V Iacovelli
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - F Petta
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - M Sperandio
- Department of Radiology, San Carlo di Nancy Hospital, Rome, Italy
| | - C Marani
- Department of Anatomo-Pathology, San Carlo di Nancy Hospital, Rome, Italy
| | - M Panei
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - S Travaglia
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - P Bove
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
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16
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Shaish H. Structured prostate MRI reporting: how and why. Abdom Radiol (NY) 2020; 45:3969-3973. [PMID: 32918578 DOI: 10.1007/s00261-020-02720-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/13/2020] [Accepted: 08/21/2020] [Indexed: 01/02/2023]
Abstract
Over the past decade, the Prostate Imaging-Reporting and Data System (PI-RADS) has revolutionized the manner in which prostate cancer is screened for, detected, biopsied, and managed. The single greatest contribution of PI-RADS has been the standardization of interpretation and reporting of findings on MRI of the prostate. This standardization has led to the wide acceptance of the PI-RADS lexicon at a time when structured reporting templates are becoming more widespread in radiology and other medical fields. The author reviews the benefits of structured reporting templates with a focus on prostate MRI, prior studies on this topic, and details of a suggested template.
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Affiliation(s)
- Hiram Shaish
- Department of Radiology, Columbia University Medical Center, 630 West 168th Street, New York, NY, 10016, USA.
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17
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PI-RADS Version 2.1: A Critical Review, From the AJR Special Series on Radiology Reporting and Data Systems. AJR Am J Roentgenol 2020; 216:20-32. [PMID: 32997518 DOI: 10.2214/ajr.20.24495] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PI-RADS version 2.1 updates the technical parameters for multiparametric MRI (mpMRI) of the prostate and revises the imaging interpretation criteria while maintaining the framework introduced in version 2. These changes have been considered an improvement, although some issues remain unresolved, and new issues have emerged. Areas for improvement discussed in this review include the need for more detailed mpMRI protocols with optimization for 1.5-T and 3-T systems; lack of validation of revised transition zone interpretation criteria and need for clarifications of the revised DWI and dynamic contrast-enhanced imaging criteria and central zone (CZ) assessment; the need for systematic evaluation and reporting of background changes in signal intensity in the prostate that can negatively affect cancer detection; creation of a new category for lesions that do not fit into the PI-RADS assessment categories (i.e., PI-RADS M category); inclusion of quantitative parameters beyond size to evaluate lesion aggressiveness; adjustments to the structured report template, including standardized assessment of the risk of extraprostatic extension; development of parameters for image quality and performance control; and suggestions for expansion of the system to other indications (e.g., active surveillance and recurrence).
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Mottet N, van den Bergh RCN, Briers E, Van den Broeck T, Cumberbatch MG, De Santis M, Fanti S, Fossati N, Gandaglia G, Gillessen S, Grivas N, Grummet J, Henry AM, van der Kwast TH, Lam TB, Lardas M, Liew M, Mason MD, Moris L, Oprea-Lager DE, van der Poel HG, Rouvière O, Schoots IG, Tilki D, Wiegel T, Willemse PPM, Cornford P. EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol 2020; 79:243-262. [PMID: 33172724 DOI: 10.1016/j.eururo.2020.09.042] [Citation(s) in RCA: 1517] [Impact Index Per Article: 379.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 09/21/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To present a summary of the 2020 version of the European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM)-European Society for Radiotherapy and Oncology (ESTRO)-European Society of Urogenital Radiology (ESUR)-International Society of Geriatric Oncology (SIOG) guidelines on screening, diagnosis, and local treatment of clinically localised prostate cancer (PCa). EVIDENCE ACQUISITION The panel performed a literature review of new data, covering the time frame between 2016 and 2020. The guidelines were updated and a strength rating for each recommendation was added based on a systematic review of the evidence. EVIDENCE SYNTHESIS A risk-adapted strategy for identifying men who may develop PCa is advised, generally commencing at 50 yr of age and based on individualised life expectancy. Risk-adapted screening should be offered to men at increased risk from the age of 45 yr and to breast cancer susceptibility gene (BRCA) mutation carriers, who have been confirmed to be at risk of early and aggressive disease (mainly BRAC2), from around 40 yr of age. The use of multiparametric magnetic resonance imaging in order to avoid unnecessary biopsies is recommended. When a biopsy is performed, a combination of targeted and systematic biopsies must be offered. There is currently no place for the routine use of tissue-based biomarkers. Whilst prostate-specific membrane antigen positron emission tomography computed tomography is the most sensitive staging procedure, the lack of outcome benefit remains a major limitation. Active surveillance (AS) should always be discussed with low-risk patients, as well as with selected intermediate-risk patients with favourable International Society of Urological Pathology (ISUP) 2 lesions. Local therapies are addressed, as well as the AS journey and the management of persistent prostate-specific antigen after surgery. A strong recommendation to consider moderate hypofractionation in intermediate-risk patients is provided. Patients with cN1 PCa should be offered a local treatment combined with long-term hormonal treatment. CONCLUSIONS The evidence in the field of diagnosis, staging, and treatment of localised PCa is evolving rapidly. The 2020 EAU-EANM-ESTRO-ESUR-SIOG guidelines on PCa summarise the most recent findings and advice for their use in clinical practice. These PCa guidelines reflect the multidisciplinary nature of PCa management. PATIENT SUMMARY Updated prostate cancer guidelines are presented, addressing screening, diagnosis, and local treatment with curative intent. These guidelines rely on the available scientific evidence, and new insights will need to be considered and included on a regular basis. In some cases, the supporting evidence for new treatment options is not yet strong enough to provide a recommendation, which is why continuous updating is important. Patients must be fully informed of all relevant options and, together with their treating physicians, decide on the most optimal management for them.
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Affiliation(s)
- Nicolas Mottet
- Department of Urology, University Hospital, St. Etienne, France.
| | | | | | | | | | - Maria De Santis
- Department of Urology, Charité Universitätsmedizin, Berlin, Germany; Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Stefano Fanti
- Department of Nuclear Medicine, Policlinico S. Orsola, University of Bologna, Italy
| | - Nicola Fossati
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Università della Svizzera Italiana, Lugano, Switzerland; Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Nikos Grivas
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jeremy Grummet
- Department of Surgery, Central Clinical School, Monash University, Caulfield North, Victoria, Australia
| | - Ann M Henry
- Leeds Cancer Centre, St. James's University Hospital and University of Leeds, Leeds, UK
| | | | - Thomas B Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Michael Lardas
- Department of Urology, Metropolitan General Hospital, Athens, Greece
| | - Matthew Liew
- Department of Urology, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Malcolm D Mason
- Division of Cancer and Genetics, School of Medicine Cardiff University, Velindre Cancer Centre, Cardiff, UK
| | - Lisa Moris
- Department of Urology, University Hospitals Leuven, Leuven, Belgium; Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium
| | - Daniela E Oprea-Lager
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, VU Medical Center, Amsterdam, The Netherlands
| | - Henk G van der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Olivier Rouvière
- Hospices Civils de Lyon, Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Lyon, France; Faculté de Médecine Lyon Est, Université de Lyon, Université Lyon 1, Lyon, France
| | - Ivo G Schoots
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Peter-Paul M Willemse
- Department of Urology, Cancer Center University Medical Center Utrecht, Utrecht, The Netherlands
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Caputo JM, Pina LA, Sebesta EM, Shaish H, Wenske S. Innovative standardized reporting template for prostate mpMRI improves clarity and confidence in the report. World J Urol 2020; 39:2447-2452. [PMID: 33079251 DOI: 10.1007/s00345-020-03487-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 10/07/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The goal of the current study was to evaluate the effect of a standardized prostate mpMRI reporting template on urologists' understanding and confidence in counselling a patient on the results of the MRI. To do this we performed a survey study to assess the understanding and confidence of urologists reviewing reports prior to (pre) and after (post) adoption of a standardized mpMRI template. METHODS Six urologists reviewed ten pre- and post- mpMRI templated reports and completed a survey to assess the clarity of key elements and the confidence in counseling the patient. The urologists were blinded to the study objective. Nonparametric constrained permutation test for significance was performed to compare the results prior to and after implementation of the template. RESULTS 29 pre- and 30 post-template mpMRI reports were reviewed. The average score for the post-template reports was significantly higher (10.7 ± 0.6 vs 7.5 ± 2.7 [ p< 0.001]) regardless of the reviewer. Urologists were also overall more confident in counselling patients when the standardized mpMRI reporting template had been used. CONCLUSION Implementation of a standardized template for reporting of prostate mpMRI findings resulted in improved clarity and confidence in counselling patients. Radiologists should consider implementing a standardized reporting template to improve clinicians' understanding and confidence of the report.
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Affiliation(s)
- Joseph M Caputo
- Department of Urology, Columbia University Medical Center, 161 Fort Washington Avenue 11th Floor, New York, NY, 10032, USA.
| | - Luis A Pina
- Department of Urology, Columbia University Medical Center, 161 Fort Washington Avenue 11th Floor, New York, NY, 10032, USA
| | - Elisabeth M Sebesta
- Department of Urology, Columbia University Medical Center, 161 Fort Washington Avenue 11th Floor, New York, NY, 10032, USA
| | - Hiram Shaish
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Sven Wenske
- Department of Urology, Columbia University Medical Center, 161 Fort Washington Avenue 11th Floor, New York, NY, 10032, USA
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20
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Goldberg-Stein S, Chernyak V. Adding Value in Radiology Reporting. J Am Coll Radiol 2020; 16:1292-1298. [PMID: 31492407 DOI: 10.1016/j.jacr.2019.05.042] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 05/23/2019] [Accepted: 05/25/2019] [Indexed: 12/29/2022]
Abstract
The major goal of the radiology report is to deliver timely, accurate, and actionable information to the patient care team and the patient. Structured reporting offers multiple advantages over traditional free-text reporting, including reduction in diagnostic error, comprehensiveness, adherence to national consensus guidelines, revenue capture, data collection, and research. Various technological innovations enhance integration of structured reporting into everyday clinical practice. This review discusses the benefits of innovations in radiology reporting to the clinical decision process, the patient experience, the cost of imaging, and the overall contributions to the health of the population. Future directions, including the use of artificial intelligence, are reviewed.
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Affiliation(s)
| | - Victoria Chernyak
- Department of Radiology, Montefiore Medical Center, Bronx, New York.
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21
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Hwang JE, Seoung BO, Lee SO, Shin SY. Implementing Structured Clinical Templates at a Single Tertiary Hospital: Survey Study. JMIR Med Inform 2020; 8:e13836. [PMID: 32352392 PMCID: PMC7226057 DOI: 10.2196/13836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 11/26/2019] [Accepted: 02/26/2020] [Indexed: 02/06/2023] Open
Abstract
Background Electronic health record (EHR) systems have been widely adopted in hospitals. However, since current EHRs mainly focus on lowering the number of paper documents used, they have suffered from poor search function and reusability capabilities. To overcome these drawbacks, structured clinical templates have been proposed; however, they are not widely used owing to the inconvenience of data entry. Objective This study aims to verify the usability of structured templates by comparing data entry times. Methods A Korean tertiary hospital has implemented structured clinical templates with the modeling of clinical contents for the last 6 years. As a result, 1238 clinical content models (ie, body measurements, vital signs, and allergies) have been developed and 492 models for 13 clinical templates, including pathology reports, were applied to EHRs for clinical practice. Then, to verify the usability of the structured templates, data entry times from free-texts and four structured pathology report templates were compared using 4391 entries from structured data entry (SDE) log data and 4265 entries from free-text log data. In addition, a paper-based survey and a focus group interview were conducted with 23 participants from three different groups, including EHR developers, pathology transcriptionists, and clinical data extraction team members. Results Based on the analysis of time required for data entry, in most cases, beginner users of the structured clinical templates required at most 70.18% more time for data entry. However, as users became accustomed to the templates, they were able to enter data more quickly than via free-text entry: at least 1 minute and 23 seconds (16.8%) up to 5 minutes and 42 seconds (27.6%). Interestingly, well-designed thyroid cancer pathology reports required 14.54% less data entry time from the beginning of the SDE implementation. In the interviews and survey, we confirmed that most of the interviewees agreed on the need for structured templates. However, they were skeptical about structuring all the items included in the templates. Conclusions The increase in initial elapsed time led users to hold a negative opinion of SDE, despite its benefits. To overcome these obstacles, it is necessary to structure the clinical templates for optimum use. In addition, user experience in terms of ease of data entry must be considered as an essential aspect in the development of structured clinical templates.
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Affiliation(s)
- Ji Eun Hwang
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Byung Ook Seoung
- Office of Medical Information, Asan Medical Center, Seoul, Republic of Korea
| | - Sang-Oh Lee
- Office of Medical Information, Asan Medical Center, Seoul, Republic of Korea.,Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soo-Yong Shin
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
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22
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Botha M, Kisansa M, Greeff W. American College of Radiology Thyroid Imaging Reporting and Data System standardises reporting of thyroid ultrasounds. SA J Radiol 2020; 24:1804. [PMID: 32161675 PMCID: PMC7059442 DOI: 10.4102/sajr.v24i1.1804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 11/26/2019] [Indexed: 01/21/2023] Open
Abstract
Background Thyroid nodules are common, the majority benign. The small risk of malignancy leads to excessive workup. Thyroid ultrasound is essential for risk stratification and management guidance. Without an organised reporting guideline, reports do not add significant value to referring clinicians. The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) was developed to aid ultrasound reporting, lessen excessive biopsies and diagnose thyroid cancers. Objectives To standardise reporting of thyroid ultrasounds by utilising an organised reporting guideline based on ACR TI-RADS. Method Thyroid ultrasound reports generated by radiology registrars at an academic hospital were studied in two phases. In Phase 1, the reports were generated as free text, and in Phase 2, using a guideline based on ACR TI-RADS. The percentages of reports that described the maximum size, the five ACR TI-RADS features and a management recommendation were compared. Results A total of 130 reports were studied. Significant improvement was observed in the description of all five ACR TI-RADS categories (p < 0.0001) from Phase 1 to Phase 2. Of all the reports, 89% included a management recommendation. Reports including an ACR TI-RADS-based recommendation increased from 48% to 75% (p < 0.05). Recommendation for biopsy increased from 35.4% to 53.8% (p < 0.05). Conclusion Introduction of an organised reporting guideline based on ACR TI-RADS, standardised reporting of thyroid ultrasounds by increasing description of thyroid nodule features and ensuring appropriate management recommendations. This, in future, will prevent underdiagnosis of thyroid cancer and unnecessary workup of benign nodules.
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Affiliation(s)
- Mariska Botha
- Department of Health, Faculty of Radiology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Margaret Kisansa
- Department of Health, Faculty of Radiology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Wim Greeff
- Department of Health, Faculty of Radiology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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23
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Zhu L, Gao G, Liu Y, Han C, Liu J, Zhang X, Wang X. Feasibility of integrating computer-aided diagnosis with structured reports of prostate multiparametric MRI. Clin Imaging 2019; 60:123-130. [PMID: 31874336 DOI: 10.1016/j.clinimag.2019.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 12/02/2019] [Accepted: 12/11/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To evaluate the feasibility of integrating computer-aided diagnosis (CAD) with structured reports of prostate multiparametric MRI (mpMRI). METHODS This retrospective study enrolled 153 patients who underwent prostate mpMRI for the purpose of targeted biopsy; patients were divided into a group with clinically significant prostate cancer (csPCa, Gleason score ≥ 3 + 4, n = 89) and a group with non-csPCa (n = 64). Ten inexperienced radiologists retrospectively evaluated these cases (single reader per case) twice using structured reports, and they were blinded to the pathologic results. Initially, the readers interpreted mpMRI without CAD. Six weeks later, they evaluated the same cases again with CAD assistance. At each time of image interpretation, lesions detected by the readers were marked on the prostate vector map in structured reports, and a PI-RADS score was given to each lesion. Diagnostic efficacy and reading time were evaluated for the two reading sessions. RESULTS With the assistance of CAD, the overall diagnostic efficacy was improved, i.e., the AUC increased from 0.83 to 0.89 (p = 0.018). Specifically, per-patient sensitivity (84.3% vs. 93.3%) and per-lesion sensitivity (76.7% vs. 88.8%) were significantly improved (all p < 0.05). Per-patient specificity with CAD (65.6%) was higher than that without CAD (56.3%), but statistical significance was not reached (p = 0.238). The reading time for each case decreased from 10.9 min to 7.8 min (p < 0.001). CONCLUSIONS It is feasible to integrate CAD with structured reports of prostate mpMRI. This reading paradigm can improve the diagnostic sensitivity of csPCa detection and reduce reading time among inexperienced radiologists.
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Affiliation(s)
- Lina Zhu
- Department of Radiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China
| | - Ge Gao
- Department of Radiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China
| | - Yi Liu
- Department of Radiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China
| | - Chao Han
- Department of Radiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China
| | - Jing Liu
- Department of Radiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China
| | - Xiaodong Zhang
- Department of Radiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China
| | - Xiaoying Wang
- Department of Radiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China.
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Gupta RT, Mehta KA, Turkbey B, Verma S. PI‐RADS: Past, present, and future. J Magn Reson Imaging 2019; 52:33-53. [DOI: 10.1002/jmri.26896] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 12/25/2022] Open
Affiliation(s)
- Rajan T. Gupta
- Department of RadiologyDuke University Medical Center Durham North Carolina USA
- Department of Surgery, Division of Urologic SurgeryDuke University Medical Center Durham North Carolina USA
- Duke Cancer Institute Center for Prostate and Urologic Cancers Durham North Carolina USA
| | - Kurren A. Mehta
- Department of RadiologyDuke University Medical Center Durham North Carolina USA
| | - Baris Turkbey
- National Cancer Institute, Center for Cancer Research Bethesda Maryland USA
| | - Sadhna Verma
- Cincinnati Veterans Hospital, University of Cincinnati Cancer InstituteUniversity of Cincinnati Medical Center Cincinnati Ohio USA
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25
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Barrett T, Rajesh A, Rosenkrantz AB, Choyke PL, Turkbey B. PI-RADS version 2.1: one small step for prostate MRI. Clin Radiol 2019; 74:841-852. [PMID: 31239107 DOI: 10.1016/j.crad.2019.05.019] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 05/30/2019] [Indexed: 12/19/2022]
Abstract
Multiparametric (mp) prostate magnetic resonance imaging (MRI) is playing an increasingly prominent role in the diagnostic work-up of patients with suspected prostate cancer. Performing mpMRI before biopsy offers several advantages including biopsy avoidance under certain clinical circumstances and targeting biopsy of suspicious lesions to enable the correct diagnosis. The success of the technique is heavily dependent on high-quality image acquisition, interpretation, and report communication, all areas addressed by previous versions of the Prostate Imaging-Reporting and Data System (PI-RADS) recommendations. Numerous studies have validated the approach, but the widespread adoption of PI-RADS version 2 has also highlighted inconsistencies and limitations, particularly relating to interobserver variability for evaluation of the transition zone. These limitations are addressed in the recently released version 2.1. In this article, we highlight the key changes proposed in PI-RADS v2.1 and explore the background reasoning and evidence for the recommendations.
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Affiliation(s)
- T Barrett
- Department of Radiology, Addenbrooke's Hospital and the University of Cambridge, Cambridge CB2 0QQ, UK.
| | - A Rajesh
- University Hospitals of Leicester NHS Trust, Leicester General Hospital, Radiology Department, Gwendolen Road, Leicester LE5 4PW, UK
| | - A B Rosenkrantz
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 660 1st Ave, Third Floor, New York, NY 10016, USA
| | - P L Choyke
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - B Turkbey
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
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Benson J, Burgstahler M, Zhang L, Rischall M. The value of structured radiology reports to categorize intracranial metastases following radiation therapy. Neuroradiol J 2019; 32:267-272. [PMID: 31017073 DOI: 10.1177/1971400919845365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Radiology descriptions of intracranial metastases following radiotherapy are often imprecise. This study sought to improve such reports by creating and disseminating a structured template that encourages discrete categorization of intracranial lesions. METHODS Following initiation of the structured template, a retrospective review assessed patients with intracranial metastases that underwent radiotherapy, comparing 'pre-template' with 'post-template' reports. A total of 139 patients were included; 94 patients (67.6%) were imaged pre-template, 45 (32.4%) post-template. Reports were assessed for discrete versus non-specific descriptions of lesions: '(presumed) new metastases', 'treated metastases', and 'indeterminate lesions'. Non-specific language was subdivided based on the type of lesion(s) described: e.g. 'stable enhancing foci' was deemed a non-specific description of 'treated metastases'. RESULTS Non-specific descriptions of lesions were used in 25/94 reports (26.6%) pre-template, and eight reports (17.8%) post-template. No significant difference was found in the frequency of inappropriate/ambiguous descriptions of intracranial lesions following template initiation (P = 0.52). However, only 27/45 (60.0%) of the reports in the post-template time period used the structured report; the other reports were written as free prose. Of the reports that did use the structured template, the authors used significantly less ambiguous language structured template (P = 0.02). CONCLUSION When utilized, a structured report template resulted in decreased non-specific descriptions and improved discrete characterization of intracranial metastases in patients treated with radiation. However, the frequency of non-specific language usage before and after template initiation was unchanged, probably due to poor compliance with template utilization.
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Affiliation(s)
| | | | - Lei Zhang
- 3 Clinical and Translational Science Institute, University of Minnesota, USA
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Hara T, Ogata T, Wada H, Yabuki T, Kanazawa S. Prostate Cancer Detection with Multiparametric MRI: A Comparison of 1 M-Concentration Gadobutrol with 0.5 M-Concentration Gadolinium-Based Contrast Agents. Curr Urol 2018; 11:201-205. [PMID: 29997463 PMCID: PMC6036578 DOI: 10.1159/000447219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/06/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Gadobutrol (Gd-DO3A-butrol) (Gadovist®) is a macrocyclic gadolinium-based contrast agent for magnetic resonance imaging (MRI) formulated at 1.0 mmol Gd/ml. Gadobutrol's higher concentration compared to other contrast agents (0.5 mmol Gd/ml) is associated with higher T1 relaxivity. We examined whether gadobutrol increases the accuracy of prostate cancer detection using dynamic contrast-enhanced MRI. MATERIALS AND METHODS Multiparametric MRI was performed in 379 patients: 94 patients received 1 M gadobutrol while 285 randomly received equivalent doses of 0.5 M gadoterate meglumine or gadopentetate dimeglumine. MRI images were retrospectively and blindly assessed for the presence of cancer by comparing them with prostate biopsy findings. RESULTS The specificity and accuracy were significantly higher with 1 M gadobutrol than 0.5 M of the other contrast agents. There were no significant differences in the sensitivity, or positive and negative predictive values. CONCLUSION Multiparametric MRI using 1 M gadobutrol may improve the accuracy of prostate cancer detection.
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Affiliation(s)
- Takeshi Hara
- Department of Radiology, NHO Iwakuni Clinical Center, Yamaguchi
| | - Takeshi Ogata
- Department of Radiology, NHO Iwakuni Clinical Center, Yamaguchi
| | - Hiroko Wada
- Department of Radiology, NHO Iwakuni Clinical Center, Yamaguchi
| | - Takayuki Yabuki
- Department of Radiology, NHO Iwakuni Clinical Center, Yamaguchi
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