Prostate MRI is an essential tool for prostate cancer workup and management, from initial screening and biopsy guidance to surveillance, treatment planning, and post-treatment monitoring, according to a talk delivered on March 4 at the ECR meeting.
Yet despite its central role, the quality of prostate MRI in real-world practice remains highly variable, and that variability can affect diagnostic accuracy and patient outcomes, said presenter Andrei Purysko, MD, of the Cleveland Clinic in Ohio.
“High-quality exams are indispensable to delivering [MRI’s] benefits,” he said.
In his presentation, Purysko outlined the scope of the problem — how best to track and improve the quality of prostate MR imaging — and described prostate MRI quality improvement initiatives, focusing particularly on the American College of Radiology’s (ACR) Prostate MR Image Quality (PI-QUAL) Improvement Collaborative.
Prostate MRI quality challenges fall into three broad categories, he explained. First, image acquisition suffers from inconsistent compliance with PI-RADS standards and scanning artifacts. Second, interpretation and reporting are hindered by variable radiologist expertise, subjective scoring criteria, and diagnostic pitfalls. Third, there is no formal requirement for performance monitoring or quality assurance/quality control at most institutions, he said. This lack of accountability allows substandard imaging to persist undetected.
To address these challenges, the American College of Radiology (ACR) launched a multipoint initiative to improve prostate MRI standards nationally through its ACR Appropriateness Criteria, its Practice Parameters and Technical Standards, a Prostate MR Virtual Course, an ACR Learning Network, and a Prostate Cancer MRI Center Designation program. But central to the ACR’s efforts is its PI-QUAL initiative, a quality improvement program built on four “pillars”: protocol optimization, patient preparation, personnel training, and performance monitoring with feedback.
“The goal of the ACR’s Prostate MR Image Quality Improvement Collaborative is to create a system that improves prostate cancer detection by increasing the number of prostate MRI exams that meet quality criteria [that is, at least 85% of scans achieving a PI-QUAL score of four or higher (on a 5-point Likert scale)],” Purysko said.
He noted that outcomes from participating institutions in the improvement collaborative have been encouraging: Across three cohorts enrolled, sites improved their rate of adequate-quality exams from a baseline of 68% to a final rate of 87%, surpassing the 85% target. He also listed similarly strong results from site-level case studies:
- At the University of Rochester Medical Center in New York, PI-QUAL ≥ 4 rates rose from 90% to 97%, while diffusion-weighted MRI quality improved from 77% to 83%.
- At UT Southwestern in Dallas, TX, a combination of PI-RADS-compliant protocols, pharmacological optimization, and a dedicated technologist journal club reduced average exam duration from 43 to 38 minutes without sacrificing quality.
- At Regional Medical Imaging in Michigan, implementation of deep-learning reconstruction enabled the institution to introduce efficient 30-minute MRI slots while meaningfully improving image quality.
What do these findings suggest? That systematic, frontline-engaged quality improvement programs can substantially and sustainably raise prostate MRI standards — even in community and outpatient settings, Purysko said.
“Mastering excellence is not a one-time optimization — it’s a continuous cycle driven by standards, data, and collaboration,” he concluded.
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