A NEW PROSTATE MAGNETIC RESONANCE IMAGING (MRI) PATHWAY.

Research summary

Background: The international Prostate Imaging – Reporting and Data System (PI-RADS) steering committee has recommended on-table radiologist monitoring of patients during MRI to improve patient outcomes by reducing the use of costly and potentially dangerous GBCA injections. On-table monitoring would also facilitate upgrading the MRI scans to whole-body MRI (WB-MRI) if distant metastases were suspected - instead of rescheduling alternative follow-up imaging appointments. In most health systems around the world,there are significant shortfalls in the number of required radiologists for routine practice,making the recommendation for additional ontable MRI monitoring unworkable. Radiographer role extension is increasing and has already been proven to successfully alleviate radiologist shortages in other areas such as colonography and radiography reporting. Methods: Multi-phase mixed-methods design comprising a stepped approach. The overarching objective is to improve the prostate MRI pathway so as to improve patients' experience. Development phase Step 1A: Systematic review Objective: A systematic review of clinical decision support systems (CDSSs) for the analysis of prostate MRI scans to establish the key clinical features used by radiologists to determine when gadolinium contrast injection or WBMRI is required. Methods: A comprehensive and structured search of the MEDLINE,Cochrane Library,and other databases will be performed to identify and review papers that studied CDSSs,and the key clinical features used by radiologists in making prostate MRI decisions (when GBCA or WB-MRI is required). Step 1B: Delphi survey. Objective: To establish the key clinical features used by radiologists in prostate MRI decisions. Methods: A national Delphi survey of radiologists will be performed to collate their expertise about how they make prostate MRI decisions. Step 1C: Building of CDSS. Objective: The development of a CDSS to assist radiographers and facilitate the PI-RADS recommendations for on-table monitoring during prostate MRI scans to decide when GBCA or WB-MRI is required. Methods: The key variables on which consensus is established in Step 1B and Step 1A will be used to build the CDSS. The key steps will be:  Design  Build  Test. Step 1D: Workshops. Objective: To reach a consensus agreement on the acceptability of the CDSS. Methods: There will be participatory workshops will with radiologists,collaborators,and patients to agree and finalise the draft pathway once it is built,and to develop content to explain to radiographers how to make each decision required to meet the aims of the research. Testing Phase Step 2A: Diagnostic accuracy test. Objective: Test the diagnostic accuracy and safety of the new prostate MRI pathway. Methods: A retrospective comparative study will be used to compare decisions made by radiographers assisted by the CDSS to those of radiologists. The study will use a large anonymised historical dataset of 800 prostate MRI patients. Anticipated impact: Patients - Faster diagnoses and a shortened pathway. Reduced need for GBCA injection and biopsy. Single outpatient appointments including WB-MRI will help to reduce carbon emissions. Radiographers - Skill and professional development. NHS - Cost saving. Dissemination: The results will be published in relevant open-access peer-reviewed journals,conference presentations,and through social media.

Principal Investigator

Anthony McIntyre

Contact us

Email: Avianna.laws@ouh.nhs.uk

IRAS number

329867