Improving MR Prostate Quality

Purpose: The overall purpose of this quality improvement project is to increase image quality, prostate cancer detection and localization. Through various interventions the goal is to improve the percentage of MR prostate exams that meet the Prostate Imaging Quality Control (Pi-Qual) scoring criteria from 89% (institutional baseline) to 94%.

Methods/Materials: Data was compiled based Pi-Qual scoring, this scoring implemented 3 scoring sequences: T2, Diffusion-weight imaging (DWI), and dynamic contrast enhanced (DCE) sequences. DCE sequences utilized a contrast bolus passing through the tissue and T1 imaging to create MR slices. These 3 types of sequences were all independently scored then combined to give an overall Pi-Qual score. The Pi-Qual score is on a scale of 1 to 5. A score of 3 is the minimum score needed for the scan to have diagnostic quality. The results were measured longitudinally till the end of the project (6 months).
Interventions included optimizing protocols, this was done by standardizing the protocol for technicians and adding references imaging that showed diagnostic and non-diagnostic quality of exams. Other interventions included standardizing sequences performed across all imaging sites and standardizing the order of sequences to reduce patient motion. The DWI protocol was improved by using a compression belt to reduce breathing motion. A more effective patient preparation was implemented by instructing patients to perform an enema, refrain from food, and ejaculation prior to exam. Additionally, adherence to preparations was ensured by notifying patients prior to the appointment to ensure patient cooperation.

Results: Ultimately at this institution, the proportion of diagnostic exams improved from 89% to 94% during the project. The proportion of diagnostic-quality DWI scans improved from 56% to 82%.

Conclusions: Interventions in prostate image quality had an institutional impact, by improving the protocols and patient preparation the scan times were reduced to 30 minutes. This increased productivity of the technologists and the radiologists. At this institution it was calculated that $558,976 in potential annual reimbursement can be made through the efforts of this project.