This AJR Special Series Review, published 2 September by an international group of prostate imagers, sets out the case for PI-QUAL — the Prostate Imaging Quality system — and a stepwise plan to use it in routine practice.
Prostate MRI now guides biopsy, staging, active surveillance, focal therapy and recurrence assessment. Poor image quality reduces cancer detection, increases equivocal PI-RADS assessments, weakens staging and longitudinal comparison, and erodes referrer confidence. PI-QUAL began as a research tool from the PRECISION trial; the European Society of Urogenital Radiology has refined it into a practical version for both multiparametric and biparametric MRI.
The authors propose multidisciplinary training, retrospective audits, protocol optimisation, structured reporting of PI-QUAL, quality dashboards, local benchmarks and AI tools. Scoring quality on every scan makes it visible and fixable. This is expert guidance rather than outcome data, but the principle — that a diagnostic score is only as good as the image — is not controversial.
- Add a PI-QUAL score to every prostate MRI report.
- Audit a sample of recent prostate MRIs with PI-QUAL to find the sequences that fail most often.
- Adjust protocols, patient preparation and hardware settings based on the audit.
- Share quality data with urology so they know when a scan can be relied on.
Why it matters
Challenges the habit of issuing a PI-RADS score without telling the urologist whether the scan could support it.
Don't overread it
This is an implementation review; PI-QUAL scoring itself has not been shown in trials to change patient outcomes.
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