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Updated: Sep 17, 2025
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
A collaborative approach to improving prostate magnetic resonance image quality
Steve J Stephen1, Peter Rosella2, Eric Weinberg2
1University of Rochester Medical Center, Rochester, USA. steve_stephen@urmc.rochester.edu.
Objective:
Poor magnetic resonance imaging (MRI) quality can lead to missed prostate cancer diagnoses. Our institution had variability in pre-MRI patient preparation, limited collaboration between radiologists and technologists, and no formal, routine image quality auditing process. The Prostate Imaging Quality system version 1 (PI-QUAL v1) is an established framework for assessing prostate MRI quality. Our quality improvement team aimed to increase the percentage of exams that received a PI-QUALv1 score of ≥ 4 and the percentage with at least one Diffusion Weighted Imaging (DWI) sequence rated optimal.
Methods:
In partnership with the American College of Radiology (ACR) Learning Network, we introduced numerous interventions to improve our baseline workflow. During our Intervention Phase (May- September 2023), our team standardized pre-MRI patient instructions and documentation regarding nil by mouth (NPO) status and bladder emptying. MRI technologists received image quality education and were involved in the image scoring process. Our team also used weekly PI-QUALv1 scoring criteria which was later embedded into the reporting system. Interventions were maintained during a Sustainment Phase (October 2023- January 2024).
Results:
1206 MRI prostate exams were audited. From the Pre-intervention to Sustainment Phase, the percentage of exams with PI-QUAL score ≥ 4 increased from 90% (95% CI: 87-94%) to 97% (95% CI: 95-99%). The percentage of exams meeting DWI criteria increased from 77% (95% CI: 74-79%) to 83% (95% CI: 78-88%). Team members reported that integrating scoring into the reporting system saved time. Patients and staff reported that standardized instructions led to a better understanding of how patient preparation improves image quality.
Conclusions:
Consistent patient preparation, team collaboration, and standardized quality scoring led to promising quality trends without using enema. PI-QUAL scores and DWI quality reached the upper limits of performance previously described by the ACR Learning Network Prostate MR QI Collaborative.
Insights
Implementing standardized patient preparation and quality scoring improved prostate MRI quality, increasing PI-QUAL scores and optimal Diffusion Weighted Imaging (DWI) sequences. This quality improvement initiative enhanced diagnostic accuracy without invasive procedures.
Area of Science:
- Medical Imaging
- Radiology
- Quality Improvement
Background:
- Poor magnetic resonance imaging (MRI) quality can compromise prostate cancer diagnosis.
- Institutional variability in patient preparation and lack of formal quality auditing impacted MRI quality.
Purpose of the Study:
- To enhance prostate MRI quality by increasing the percentage of exams meeting a PI-QUAL score of ≥4.
- To improve the proportion of exams with optimal Diffusion Weighted Imaging (DWI) sequences.
Main Methods:
- Standardized pre-MRI patient instructions (NPO, bladder emptying) and technologist education.
- Implemented weekly Prostate Imaging Quality (PI-QUAL) v1 scoring, integrated into the reporting system.
- Partnership with the American College of Radiology (ACR) Learning Network.
Main Results:
- Proportion of exams with PI-QUAL score ≥4 increased from 90% to 97%.
- Proportion of exams meeting optimal DWI criteria rose from 77% to 83%.
- Integrated scoring saved time; standardized instructions improved patient and staff understanding.
Conclusions:
- Consistent patient preparation, team collaboration, and standardized scoring improved prostate MRI quality without enemas.
- Achieved high PI-QUAL scores and DWI quality, meeting benchmarks from the ACR Learning Network.
- Quality improvement efforts demonstrated significant positive trends in prostate MRI assessment.
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