Rationale and Objectives
Assess the impact of implementing a structured report template and a computer-aided diagnosis (CAD) tool on the quality of prostate multiparametric magnetic resonance imaging (mp-MRI) reports.
Materials and Methods
Institutional Review Board approval was obtained for this Health Insurance Portability and Accountability Act–compliant study performed at an academic medical center. The study cohort included all prostate mp-MRI reports ( n = 385) finalized 6 months before and after implementation of a structured report template and a CAD tool (collectively the information technology [IT] tools) integrated into the picture archiving and communication system workstation. Primary outcome measure was quality of prostate mp-MRI reports. An expert panel of our institution’s subspecialty-trained abdominal radiologists defined prostate mp-MRI report quality as optimal, satisfactory, or unsatisfactory based on documentation of nine variables. Reports were reviewed to extract the predefined quality variables and determine whether the IT tools were used to create each report. Chi-square and Student’s t tests were used to compare report quality before and after implementation of IT tools.
Results
The overall proportion of optimal or satisfactory reports increased from 29.8% (47/158) to 53.3% (121/227) ( P < .001) after implementing the IT tools. Although the proportion of optimal or satisfactory reports increased among reports generated using at least one of the IT tools (47/158 = [29.8%] vs. 105/161 = [65.2%]; P < .001), there was no change in quality among reports generated without use of the IT tools (47/158 = [29.8%] vs. 16/66 = [24.2%]; P = .404).
Conclusions
The use of a structured template and CAD tool improved the quality of prostate mp-MRI reports compared to free-text report format and subjective measurement of contrast enhancement kinetic curve.
Multiparametric magnetic resonance imaging (mp-MRI) is a well-established, noninvasive modality for prostate cancer diagnosis , staging , biopsy targeting , and treatment planning . However, variation in what results are reported and how they are presented remains a barrier to widespread adoption of mp-MRI in clinical practice .
Measuring the quality of radiology reports is a complex task , particularly because of the lack of report standardization and objective key performance indicators . Free-text reports are typically not standardized, thus varying in content and format. Structured report templates have been developed to provide a consistent format and promote use of standard terminology . Compared to conventional, free-text reports, in addition to improving communication of test results, structured reports allow information to be retrieved and reused more easily . However, evidence of the impact of structured templates on the quality of radiology reports compared to free-text format is inconsistent .
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Materials and methods
Study Design and Setting
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Intervention
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Study Population
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Outcome Measures
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Table 1
Categorization of the Quality of Prostate Mp-MRI Reports
Quality Variables ∗ Report Quality Categories Optimal Satisfactory Unsatisfactory Prostate size Volume 3 Planes <3 Planes Focal lesion size 3 Planes or volume ≥2 Planes <2 Planes Restricted diffusion ADC value Documented Not documented Contrast enhancement Curve or quality † Documented Not documented T1 intensity/hemorrhage Documented Not documented Not documented T2 intensity Documented Documented Not documented Focal lesion segmental location ‡ Documented Documented Not documented Local invasion § Documented Documented Not documented Lymph nodes involvement Documented Documented Not documented
ADC, apparent diffusion coefficient; Mp-MRI, multiparametric magnetic resonance imaging.
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Data Collection
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Statistical Analysis and Sample Size
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Results
Patient and Report Characteristics
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Table 2
Patient-Related Characteristics Based on 385 Prostate Multiparametric Magnetic Resonance Imaging Reports
Characteristic Before ( n = 158) After ( n = 227)P Value Age (mean [years] ± standard deviation [SD]) ∗ 64.2 ± 8.6 63.3 ± 9.1 0.293 Prostate-specific antigen (PSA) documented † 125/158 (79.1) 194/227 (85.5) 0.104 PSA (mean [ng/mL] ± SD) ∗ 8.1 ± 12.2 8.2 ± 7.4 0.880 Biopsy-proven cancer documented † 140/158 (88.6) 187/227 (82.4) 0.093 Gleason documented † 105/158 (66.5) 159/227 (70.0) 0.456 Gleason (mean ± SD) ∗ 6.88 ± 0.9 6.83 ± 1.0 0.668 Focal lesion present † 121/152 (79.6) 170/224 (75.9) 0.398
Data presented in the parenthesis are percentages.
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Structured Template and CAD Tool Utilization
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Report Quality
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Table 3
Documentation of Quality Variables Before and After the Implementation of a Structured Report Template and a Computer-Aided Diagnosis Tool
Quality Variables ∗ Before ( n = 158) After ( n = 227)P Value Prostate size in three planes 151 (95.6) 205 (90.3) 0.054 Prostate volume 149 (94.3) 222 (97.8) 0.072 Focal lesion presence documented 152 (96.2) 224 (98.7) 0.114 Focal lesion segmental location † 117 (74.1) 166 (73.1) 0.840 Focal lesion size ‡ ≥2 Planes 79 (65.3) 137 (80.6)0.003 Three planes or volume 24 (19.8) 73 (42.9)<0.001 Restricted diffusion Documented 139 (88.0) 202 (89.0) 0.759 ADC value 1 (0.63) 100 (44.1)<0.001 Contrast enhancement Documented 111 (70.3) 183 (80.6)0.019 Curve/quality § 4 (2.5) 87 (38.3)<0.001 T2 intensity 152 (96.2) 214 (94.3) 0.390 T1 intensity 78 (49.4) 115 (50.7) 0.803 Local invasion ‖ 131 (82.9) 213 (93.8)<0.001 Lymph nodes involvement 156 (100) 155 (99.6) 0.404
Data presented in the parenthesis are percentages. Values in bold are statistically significant.
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Discussion
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Conclusions
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Supplementary Data
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