Abstract
Objective
To assess the effect of interactive dedicated training on radiology fellows’ accuracy in assessing prostate cancer on MRI.
Methods
Eleven radiology fellows, blinded to clinical and pathological data, independently interpreted preoperative prostate MRI studies, scoring the likelihood of tumour in the peripheral and transition zones and extracapsular extension. Each fellow interpreted 15 studies before dedicated training (to supply baseline interpretation accuracy) and 200 studies (10/week) after attending didactic lectures. Expert radiologists led weekly interactive tutorials comparing fellows’ interpretations to pathological tumour maps. To assess interpretation accuracy, receiver operating characteristic (ROC) analysis was conducted, using pathological findings as the reference standard.
Results
In identifying peripheral zone tumour, fellows’ average area under the ROC curve (AUC) increased from 0.52 to 0.66 (after didactic lectures; p < 0.0001) and remained at 0.66 (end of training; p < 0.0001); in the transition zone, their average AUC increased from 0.49 to 0.64 (after didactic lectures; p = 0.01) and to 0.68 (end of training; p = 0.001). In detecting extracapsular extension, their average AUC increased from 0.50 to 0.67 (after didactic lectures; p = 0.003) and to 0.81 (end of training; p < 0.0001).
Conclusion
Interactive dedicated training significantly improved accuracy in tumour localization and especially in detecting extracapsular extension on prostate MRI.
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References
Fuchsjäger M, Shukla-Dave A, Akin O, Barentsz J, Hricak H (2008) Prostate cancer imaging. Acta Radiol 49:107–120
Akin O, Hricak H (2007) Imaging of prostate cancer. Radiol Clin North Am 45:207–222
Claus FG, Hricak H, Hattery RR (2004) Pretreatment evaluation of prostate cancer: role of MR imaging and 1H MR spectroscopy. Radiographics 24:S167–180
Rifkin MD, Zerhouni EA, Gatsonis CA, Quint LE, Paushter DM, Epstein JI, Hamper U, Walsh PC, McNeil BJ (1990) Comparison of magnetic resonance imaging and ultrasonography in staging early prostate cancer. Results of a multi-institutional cooperative trial. N Engl J Med 323:621–626
Schiebler ML, Yankaskas BC, Tempany C, Spritzer CE, Rifkin MD, Pollack HM, Holtz P, Zerhouni EA (1992) MR imaging in adenocarcinoma of the prostate: interobserver variation and efficacy for determining stage C disease. AJR Am J Roentgenol 158:559–562
Tempany CM, Zhou X, Zerhouni EA, Rifkin MD, Quint LE, Piccoli CW, Ellis JH, McNeil BJ (1994) Staging of prostate cancer: results of Radiology Diagnostic Oncology Group project comparison of three MR imaging techniques. Radiology 192:47–54
Yu KK, Hricak H, Alagappan R, Chernoff DM, Bacchetti P, Zaloudek CJ (1997) Detection of extracapsular extension of prostate carcinoma with endorectal and phased-array coil MR imaging: multivariate feature analysis. Radiology 202:697–702
Mullerad M, Hricak H, Wang L, Chen HN, Kattan MW, Scardino PT (2004) Prostate cancer: detection of extracapsular extension by genitourinary and general body radiologists at MR imaging. Radiology 232:140–146
Hom JJ, Coakley FV, Simko JP, Qayyum A, Lu Y, Schmitt L, Carroll PR, Kurhanewicz J (2006) Prostate cancer: endorectal MR imaging and MR spectroscopic imaging—distinction of true-positive results from chance-detected lesions. Radiology 238:192–199
Obuchowski NA (1997) Nonparametric analysis of clustered ROC curve data. Biometrics 53:567–578
Akin O, Sala E, Moskowitz CS, Kuroiwa K, Ishill NM, Pucar D, Scardino PT, Hricak H (2006) Transition zone prostate cancers: features, detection, localization, and staging at endorectal MR imaging. Radiology 239:784–792
Li H, Sugimura K, Kaji Y, Kitamura Y, Fujii M, Hara I, Tachibana M (2006) Conventional MRI capabilities in the diagnosis of prostate cancer in the transition zone. AJR Am J Roentgenol 186:729–742
Futterer JJ, Engelbrecht MR, Huisman HJ, Jager GJ, Hulsbergen-van De Kaa CA, Witjes JA, Barentsz JO (2005) Staging prostate cancer with dynamic contrast-enhanced endorectal MR imaging prior to radical prostatectomy: experienced versus less experienced readers. Radiology 237:541–549
Halligan S (2002) Subspecialist radiology. Clin Radiol 57:982–983
Sickles EA, Wolverton DE, Dee KE (2002) Performance parameters for screening and diagnostic mammography: specialist and general radiologists. Radiology 224:861–869
Kan L, Olivotto IA, Warren Burhenne LJ, Sickles EA, Coleman AJ (2000) Standardized abnormal interpretation and cancer detection ratios to assess reading volume and reader performance in a breast screening program. Radiology 215:563–567
Linver MN, Paster SB, Rosenberg RD, Key CR, Stidley CA, King WV (1992) Improvement in mammography interpretation skills in a community radiology practice after dedicated teaching courses: 2-year medical audit of 38,633 cases. Radiology 184:39–43
European Society of Gastrointestinal and Abdominal Radiology CT Colonography Group Investigators (2007) Effect of directed training on reader performance for CT colonography: multicenter study. Radiology 242:152–161
Sala E, Akin O, Moskowitz CS, Eisenberg HF, Kuroiwa K, Ishill NM, Rajashanker B, Scardino PT, Hricak H (2006) Endorectal MR imaging in the evaluation of seminal vesicle invasion: diagnostic accuracy and multivariate feature analysis. Radiology 238:929–937
Wang L, Mullerad M, Chen HN, Eberhardt SC, Kattan MW, Scardino PT, Hricak H (2004) Prostate cancer: incremental value of endorectal MR imaging findings for prediction of extracapsular extension. Radiology 232:133–139
Girouin N, Mège-Lechevallier F, Tonina Senes A, Bissery A, Rabilloud M, Maréchal JM, Colombel M, Lyonnet D, Rouvière O (2007) Prostate dynamic contrast-enhanced MRI with simple visual diagnostic criteria: is it reasonable? Eur Radiol 17:1498–1509
Mazaheri Y, Shukla-Dave A, Hricak H, Fine SW, Zhang J, Inurrigarro G, Moskowitz CS, Ishill NM, Reuter VE, Touijer K, Zakian KL, Koutcher JA (2008) Prostate cancer: identification with combined diffusion-weighted MR imaging and 3D 1H MR spectroscopic imaging—correlation with pathologic findings. Radiology 246:480–488
Lemaitre L, Puech P, Poncelet E, Bouyé S, Leroy X, Biserte J, Villers A (2009) Dynamic contrast-enhanced MRI of anterior prostate cancer: morphometric assessment and correlation with radical prostatectomy findings. Eur Radiol 19:470–480
Fuchsjäger M, Akin O, Shukla-Dave A, Pucar D, Hricak H (2009) The role of MRI and MRSI in diagnosis, treatment selection, and post-treatment follow-up for prostate cancer. Clin Adv Hematol Oncol 7:193–202
Mueller-Lisse U, Mueller-Lisse U, Scheidler J, Klein G, Reiser M (2005) Reproducibility of image interpretation in MRI of the prostate: application of the sextant framework by two different radiologists. Eur Radiol 15:1826–1833
Kohn LT, Corrigan JM, Donaldson MS (2000) To err is human: building a safer health system. National Academy, Washington, DC
Sibley JC, Sackett DL, Neufeld V, Gerrard B, Rudnick KV, Fraser W (1982) A randomized trial of continuing medical education. N Engl J Med 306:511–555
Davis D, O’Brien MA, Freemantle N, Wolf FM, Mazmanian P, Taylor-Vaisey A (1999) Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes? JAMA 282:867–874
Chan S, Gunderman RB (2005) Emerging strategic themes for guiding change in academic radiology departments. Radiology 236:430–440
Acknowledgments
This work was supported by NIH Grant # R01 CA76423. The authors thank the readers who participated in this study, Richard Batz, Sandra Brennan, Sean Curran, Devish Dixit, Jonathan Landa, Anthony Miller, Christopher Riedl, Simran Sandhu, Claire Smith, Tade Tadic and Mohammed Talukder; Halley F. Eisenberg for data collection; Samson W. Fine for providing pathology tumour maps; and Ada Muellner for manuscript editing.
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Oguz Akin and Christopher C. Riedl are joint first authors.
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Akin, O., Riedl, C.C., Ishill, N.M. et al. Interactive dedicated training curriculum improves accuracy in the interpretation of MR imaging of prostate cancer. Eur Radiol 20, 995–1002 (2010). https://doi.org/10.1007/s00330-009-1625-x
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DOI: https://doi.org/10.1007/s00330-009-1625-x