Improving prostate MRI quality assessment across diverse evaluators and institutional practice through a PI-QUAL v2 lecture: a pilot study

To evaluate the impact of a prostate imaging quality (PI-QUAL) v2 lecture on the accuracy and inter-reader agreement of prostate MRI image-quality assessment among radiologists and technologists from diverse professional backgrounds and institutions, and to evaluate its role in institutional-level quality improvement through a quality control (QC) process.

Ten participants (five radiologists and five technologists) from five different hospitals independently evaluated 15 prostate MRIs before and after a standardized PI-QUAL v2 lecture. Reference scores were established by two experienced radiologists. Concordance with reference was assessed using accuracy and balanced accuracy. Inter-reader agreement was measured using percent agreement (PA) and Gwet's AC1. Subgroup analyses were conducted based on participant characteristics. For the quality assurance and QC (QA/QC), each center submitted 15 prostate MRIs before and after the lecture. Image quality was evaluated centrally to assess institutional improvement.

Overall accuracy increased from 66.7% to 76.7%, and balanced accuracy increased from 62.9% to 84.2%; the mixed-effects model indicated significantly higher post-lecture accuracy (p = 0.038). Accuracy was also higher across all subgroups. Inter-reader agreement improved from PA 57.6% to 72.6% and Gwet's AC1 from 0.214 to 0.466. Through the QA/QC process, three centers initially failed to meet PI-QUAL v2 technical criteria. After feedback, all post-intervention scans achieved PI-QUAL v2 scores > 1.

A structured PI-QUAL v2 lecture improved both the accuracy and inter-reader agreement of prostate MRI image-quality assessments among diverse evaluators. Incorporating QA/QC further enhanced institutional image quality. PI-QUAL v2 training is a feasible strategy for standardizing prostate MRI quality.

Question Does a structured PI-QUAL v2 lecture for radiologists and technologists improve prostate MRI quality assessment performance and institutional imaging practice across institutions? Findings PI-QUAL v2 training improved accuracy (66.7% to 76.7%) and inter-reader agreement in prostate MRI quality assessment, while QA/QC feedback enhanced institutional imaging quality. Clinical relevance statement Structured PI-QUAL v2 education combined with quality assurance and quality control feedback improves evaluator consistency and institutional prostate MRI quality, facilitating standardized image-quality assessment and broader implementation of high-quality prostate MRI in clinical radiology.