DOI:10.1001/jamaoncol.2025.1594 -MRI-screening reduces unnecessary Bx. -Aggressive PCa detection increase with MRI. -Overdiagnosis of insign PCa drops -Benefit/harm improves with each screening round. -MRI sustains efficiency+safety over repeated rounds. -Fewer Bx’s in subsequent screening rounds.

3 Papers about PI-QUAL v2 (Prostate MR Image Quality Assessment) The original paper (1st image) is open access. Please find images from the other 2: Eur Rad and Eur Urol Original de Rooij et al. European Radiology (2024) 34:7068–7079 doi.org/10.1007/s003... #QualityMatters #Prostate #ProstateMRI

Image Quality in Radiology

Giorgio Bembrilla @ECR2025 - Always do a PI-QUAL check in a prostate MRI - Adhere to PI-RADS technical standards

Voor mijn podcast #TegenHetLicht over #ProstaatMRI luister: open.spotify.com/episode/5sxs...

Biopsy result: 65 yrs, PSA 21, PSAD 0.54, cT2 --> PI-RADS 5, mT3a, DCE ++ Pathology: - GS: 4+3, with invasive cribriform growth

Answer to yesterday's case: - PI-RADS 5: internal invasive growth, >15 mm Score: T2W/DWI/DCE: 5/5/+  PI-RADS 5 - MRI stage T3a (mT3a): bulge, broad contact, invasive - Value of DCE: early enhancement, arterial curve-like  high probability of Gleason 4 component

65 yrs, PSA 21, PSAD 0.54, cT2 PI-RADS assessment? MRI stage (mT?) Value of DCE?

• PI-QUALv2 standardized system for prostate MRI quality • High quality is essential: 30% mp and 50% of bpMR are not adequate in NL • Certified radiologists key for PI-QUALv2 standards • Implementing PI-QUALv2 in research (papers) and clinics is crucial rdcu.be/d8NBe

www.linkedin.com/posts/jelle-... Important Update on Prostate MRI Quality! Push for higher-quality prostate MRI is essential for accurate diagnosis and patient care! ✅ Include PI-QUAL in all reports ✅ Quality Control should in the guidelines ✅ Scientific papers should mention PI-QUAL

83 yr PSA 13,2 PSAD 0,29 DRE T2R Answer: PI-RADS 5 in d.d.: granulomatous prostatitis (GP) Always biopsy to exclude sign-PCa T2W: Patchy organized chaos + some erased charcoal DWI: Patchy areas of low ADC (minimal 467) DCE: areas of central lack of enhancement Diagnosis: GP + central necrosis

Diagnosis? Male 83 yrs; PSA 13,2; PSAD 0,29; DRE: T2R What are your thoughts? - significant cancer? - something else? - must a biopsy be performed?

It’s inverted! Sadly, many of us exhibit high Ego, high Euro, and low Empathy. Let’s strive to restore the pyramid to its proper orientation By doing so, we’ll create a far better world for all.

The Three E’s: - Ego - Euro - Empathy (Human = E3) We’re all unique due to our varying proportions of these traits. What’s wrong with this pyramid?

Summary of recent literature on AI in PCa: • AI improves less experienced radiologist • AI models reduce unnecessary biopsies by better identifying low-risk PCa. • Challenges are standardization, and clinical integration of AI • Prospective clinical validation of AI is needed

Our 3-day PI-RADS workshop in South Africa was a big success! Passionate participants learned to use prostate MRI. We’re proud to have trained half of all radiologists here. Big thank you to everyone who made this possible! Bring this course to your region, just contact me: [email protected]