So, there's this 1-5—someone scores it after there's an MRI, right?
Yeah.
And the question is, a guy like you scores it?
Yes, a radiologist.
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.
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
Or Michigan?
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?
And the magic answer they're looking for... The tight magic answer they're looking for
to feel comfortable is...
50, but...
50 cases.
50 cases with...
Or taken this course.
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.
Right.
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.
Okay.
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.
But they should ask for the credibility. How do I know that this person has experience?
Yeah.
And you're looking for an answer in terms of number of cases or you also said that they
got their certificate.
Right.
What's the official name of the certificate?
The ACR Prostate Teaching Course.
ACR Prostate Teaching Course. That's incredibly helpful.
Yeah.
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?
Yeah.
Is that fair to say?
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.
Yeah.
But I've read more than 50 prostate MR's.
Yeah, but it's important.
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...
Yeah.
She's the one.