Prostate MRI now carries far more than pre-biopsy triage: biopsy targeting, local staging, active surveillance, focal therapy planning, post-treatment surveillance and assessment of biochemical recurrence all depend on it. Image quality determines whether any of that is reliable. Poor quality reduces cancer detection, pushes assessments into the equivocal PI-RADS 3 bin, undermines staging and longitudinal comparison, and erodes urological confidence in MRI-directed care.
The Prostate Imaging Quality system was built as a research quality-control tool on PRECISION trial data and has since been revised by the European Society of Urogenital Radiology into a version meant for routine use, applicable to both multiparametric and biparametric studies. This review sets out a stepwise route into practice: multidisciplinary training, retrospective audit of existing studies, protocol optimisation, structured reporting that carries the quality score, quality dashboards, local benchmarks, and AI tools where available.
The step that changes things is putting the score in the report. A radiologist who records that a study was of inadequate diagnostic quality has converted an invisible problem into a visible one — the urologist knows what weight to give a negative MRI, the patient can be recalled rather than biopsied blind, and the department accumulates a record that justifies fixing the protocol or the coil. Without that, quality failures are absorbed silently as equivocal reports. Start with a retrospective audit of a month of studies; the pattern of failure is usually a small number of fixable sequence and preparation problems rather than the scanner.
- Put a PI-QUAL score in every prostate MRI report from now on.
- Audit a month of past studies first — the failures usually cluster on a few sequences.
- Use the revised ESUR version, which applies to biparametric as well as multiparametric protocols.
- Agree with urology what an inadequate-quality study means for the next step.
- Track the score over time; a dashboard makes a protocol problem arguable with the department.
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