Video: Prostate MRI: Finding an Experienced Radiologist | Off the Cuff With Mark Moyad, MD, MPH
Off the Cuff With Mark Moyad, MD, MPH | Transcript
Dr. Moyad: So, there's this 1-5—someone scores it after there's an MRI, right?
Dr. Margolis: Yeah.
Dr. Moyad: And the question is, a guy like you scores it?
Dr. Margolis: Yes, a radiologist.
Dr. Moyad: A radiologist scores it. What I never hear enough about—I haven't heard it at all—is this is also subjective, so why am I not going to somebody like you who have seen a ton of these? Because in the hands of someone that hasn't seen a lot of these and graded PI-RADS, I'm getting nervous. So, can you explain to the audience how important, how that experience is not just important throughout the rest of the spectrum of prostate cancer, but it's also when it comes to the MRI and then the other imaging.
Dr. Margolis: So, the important thing to keep in mind is the surgeon or the oncologist or the radiation therapist is going to have a relationship with a radiologist. So when your physician says you need to get a prostate MRI and here's where you should get it down, it's not just, you know, "I'm getting a special deal, he takes me out to dinner." It's because the reports are reliable and this data is something that the referring person understands, and in some cases if you're planning a targeted biopsy, it has to be done with a certain protocol and at a certain location so that the data can be transferred to the image-fusion targeted-biopsy system.
So education is important. As a member of the American College of Radiology, we have a training program. So we go through 50 cases—where we know the outcome—of various levels of complexity and various suspicion levels with the radiologists that are training to read prostate MRI. And they get a certificate when they're done with the course. Obviously, you don't need that to read prostate MR, but it's fair to ask a radiologist, "How did you learn to read prostate MR?" Now, very newly minted radiologists who have done a fellowship at a center of excellence like Cornell or UCLA.
Dr. Moyad: Or Michigan?
Dr. Margolis: Or Michigan, or NYU. Put a shout-out to my frenemies down the street. They've seen, you know, at least 50 and probably hundreds of prostate MR's and read them with people that are experienced. So, it's not ill-advised to ask your radiologist who's reading this and how did he or she learn to read prostate MR's?
Dr. Moyad: And the magic answer they're looking for... The tight magic answer they're looking for to feel comfortable is…
Dr. Margolis: 50, but…
Dr. Moyad: 50 cases.
Dr. Margolis: 50 cases with…
Dr. Moyad: Or taken this course.
Dr. Margolis: Well, that's the thing. 50 cases with known follow-up. So just because you read 50 cases, if you don't know if you were right or not that doesn't really help.
Dr. Moyad: Right.
Dr. Margolis: At academic teaching institutions, you know, we keep track of, you know, this is what we said and this is what we found on follow up and we have peer-review where we go back to say oh, you know, you said this one was PI-RADS 5—high-suspicion—it was negative, and so, but when we look at the pathology it turns out, you know, maybe there was granulomatous prostatitis, which is an inflammatory condition, but maybe there was just a lot of artifact on the image and you misread it, and so we continuously readjust how we interpret these things.
Dr. Moyad: Okay.
Dr. Margolis: So, most sites doing prostate MR have one or two people that are the, you know, the man or woman that does it for that facility.
Dr. Moyad: But they should ask for the credibility. How do I know that this person has experience?
Dr. MargolisYeah.
Dr. Moyad: And you're looking for an answer in terms of number of cases or you also said that they got their certificate.
Dr. Margolis: Right.
Dr. Moyad: What's the official name of the certificate?
Dr. Margolis: The ACR Prostate Teaching Course.
Dr. Moyad: ACR Prostate Teaching Course. That's incredibly helpful.
Dr. Margolis: Yeah.
Dr. Moyad: I mean both of those things because you work in an area where I've seen, for the most with patients, the most of any other area of prostate cancer where people don't think of it the same way they think of surgery and radiation and pathology—that experience matters—that you could just set up a facility and start doing cases and then you'll get your PI-RADS right, right?
Dr. Margolis: Yeah.
Dr. Moyad: Is that fair to say?
Dr. Margolis: And there is a lot of concern in the urology community and the radiation oncology community, in the medical oncology community and in the radiology community about... this is not a technology that we should release willy-nilly to the public. So, Jelle Barentsz, who's from Nijmegen in the Netherlands, who's the world's premier expert in prostate imaging, and Jeff Weinreb at Yale who leads to the ACR PI-RADS committee are working on a more formalized way to provide this kind of certificate to places like, you know, like I haven't taken the course. I teach the course, but I haven't taken it.
Dr. Moyad: Yeah.
Dr. Margolis: But I've read more than 50 prostate MR's.
Dr. Moyad: Yeah, but it's important.
Dr. Margolis: Right. And so Katarzyna Macura from Hopkins, which is one of the leading places for prostate cancer treatment. She's the head radiologist for prostate imaging there and she runs the course. So if anybody is going to have surgeons that are more preoccupied with her skill level...
Dr. Moyad: Yeah.
Dr. Margolis: She's the one.