Faculty Bibliography

Magnetic resonance imaging (MRI) has become integral to diagnosing and managing patients with suspected or confirmed prostate cancer. However, the benefits of utilizing MRI can be hindered by quality issues during imaging acquisition, interpretation, and reporting. As the utilization of prostate MRI continues to increase in clinical practice, the variability in MRI quality and how it can negatively impact patient care have become apparent. The American College of Radiology (ACR) has recognized this challenge and developed several initiatives to address the issue of inconsistent MRI quality and ensure that imaging centers deliver high-quality patient care. These initiatives include the Prostate Imaging Reporting and Data System (PI-RADS), developed in collaboration with an international panel of experts and members of the European Society of Urogenital Radiology (ESUR), the Prostate MR Image Quality Improvement Collaborative, which is part of the ACR Learning Network, the ACR Prostate Cancer MRI Center Designation, and the ACR Appropriateness Criteria. In this article, we will discuss the importance of these initiatives in establishing quality assurance and quality control programs for prostate MRI and how they can improve patient outcomes.

BACKGROUND:Three-dimensional (3D) printed anatomic models can facilitate presurgical planning by providing surgeons with detailed knowledge of the exact location of pertinent anatomical structures. Although 3D printed anatomic models have been shown to be useful for pre-operative planning, few studies have demonstrated how these models can influence quantitative surgical metrics. OBJECTIVE:To prospectively assess whether patient-specific 3D printed prostate cancer models can improve quantitative surgical metrics in patients undergoing robotic-assisted radical prostatectomy (RARP). METHODS:Patients with MRI-visible prostate cancer (PI-RADS V2 ≥ 3) scheduled to undergo RARP were prospectively enrolled in our IRB approved study (n = 82). Quantitative surgical metrics included the rate of positive surgical margins (PSMs), operative times, and blood loss. A qualitative Likert scale survey to assess understanding of anatomy and confidence regarding surgical approach was also implemented. RESULTS:The rate of PSMs was lower for the 3D printed model group (8.11%) compared to that with imaging only (28.6%), p = 0.128. The 3D printed model group had a 9-min reduction in operating time (213 ± 42 min vs. 222 ± 47 min) and a 5 mL reduction in average blood loss (227 ± 148 mL vs. 232 ± 114 mL). Surgeon anatomical understanding and confidence improved after reviewing the 3D printed models (3.60 ± 0.74 to 4.20 ± 0.56, p = 0.62 and 3.86 ± 0.53 to 4.20 ± 0.56, p = 0.22). CONCLUSIONS:3D printed prostate cancer models can positively impact quantitative patient outcomes such as PSMs, operative times, and blood loss in patients undergoing RARP.

PURPOSE/OBJECTIVE:With radiology practices increasingly employing nonphysician practitioners (NPPs), we aimed to characterize specific NPP clinical roles. METHODS:Linking 2017 to 2019 Medicare data sets, we identified all claims-submitting nurse practitioners and physician assistants (together NPPs) employed by radiologists. NPP-billed services were identified, weighted by work relative value units, and categorized as (1) clinical evaluation and management (E&M), (2) invasive procedures, and (3) noninvasive imaging interpretation. NPP practice patterns were assessed temporally and using frequency analysis. RESULTS:As the number of radiologist-employed NPPs submitting claims increased 16.3% (from 523 in 2017 to 608 in 2019), their aggregate Medicare fee-for-service work relative value units increased 17.3% (+40.0% for E&M [from 79,540 to 111,337]; +5.6% for procedures [from 179,044 to 189,003]; and +74.0% for imaging [from 5,087 to 8,850]). The number performing E&M, invasive procedures, and imaging interpretation increased 7.6% (from 329 to 354), 18.3% (from 387 to 458), and 31.8% (from 85 to 112), with 58.2%, 75.3%, and 18.4% billing those services in 2019. Paracentesis and thoracentesis were the most frequently billed invasive procedures. Fluoroscopic swallowing and bone densitometry examinations were the most frequently billed imaging services. By region, NPPs practicing as majority clinical E&M providers were most common in the Midwest (33.5%) and South (33.0%), majority proceduralists in the South (53.1%), and majority image interpreters in the Midwest (50.0%). CONCLUSIONS:As radiology practices employ more NPPs, radiologist-employed NPPs' aggregate services have increased for E&M, invasive procedures, and imaging interpretation. Most radiologist-employed NPPs perform invasive procedures and E&M. Although performed by a small minority, imaging interpretation has shown the largest relative service growth.