So you want to start a prostate mpMRI practice?


A radiologist shares his tips for building a successful program.

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So you want to start a multiparametric prostate MRI (mpMRI) practice? You are not alone…and you can do it. That said, the decision of whether or not to enter into the expanding clinical space of prostate mpMRI is complex and one that should not be entered into lightly.

There is no question that today’s mpMRI technology allows for superior detection and characterization of prostate cancer than ever before. However, with this great power comes great responsibility. Performing suboptimal mpMRI scans and interpretations can potentially be more harmful than not doing prostate mpMRI at all. This is because many key clinical management decisions are based on information provided by prostate mpMRI; therefore, understanding the strengths and limitations of the technique and the individuals interpreting the exams is critical.

So after this initial soul-searching, you have decided that you are ready to start…so now, how do you build it? There is an art and science to building a successful prostate mpMRI program. Much has been written on the science of prostate mpMRI, including the ACR PI-RADS™ version two document, a must read for anyone entering this field. Also, quality, safety, and clinical expertise must be present in order to make a successful clinical practice, but these only make up part of the equation for success. As with most things, science will only take you so far.

Here are some tips for success in the art of practice building:

Be the champion. Every successful project needs a champion willing to ardently fight for and defend it. This is no exception. If you are reading this, you may have already determined that you will serve in this capacity for your program. If not, you must identify someone in your practice who will. This is a critical element for success, as this will be an uphill climb.

Know and connect with your referrers. Referrals are essential to any successful clinical practice. Help your referrers understand the added value that you can provide them as imaging specialists in prostate mpMRI. Always make yourself available to your referrers as it will go a long way in building trust. Strong relationships are a key building block of a successful clinical practice. Finally, it is imperative that you listen to them and understand their pain points so that you can help to deal with those.

Speak the same language and bridge the communication gap. When imaging patients, complex patient data is compressed to megabytes when sent to a PACS system and often distilled to kilobyte sized documents when presented back to the referring clinician; this compression leads to data loss and it is critical to bridge that gap to ensure that important information is not lost in transit. One way to do this is to work to standardize the nomenclature with your colleagues in your practice, as well as with your referral base. The good news here is that with PI-RADS version two, an infrastructure is in place for clear communication between you, your referrers, and your patients.

Keep learning. The rapid rate of evolution in the field is exciting but also requires radiologists to stay current and abreast of the newest literature. It is key that groups commit to making their practices cutting edge through adaptation of new technologies and techniques and committing to rigorous and meaningful quality improvement activities. In addition to staying current with the literature, attending hands-on courses is an excellent way to maintain and build skill.

In conclusion, building a clinical practice in prostate mpMRI can be a daunting task that requires substantial hard work and dedication. However, understanding the art and science of practice building will help define the roadmap for success. Again, with great power comes great responsibility, but also the possibility for great rewards for you, your referrers and your patients.

Gupta Rajan T 2Rajan T. Gupta, MD, is associate professor of radiology, assistant professor of surgery, and director of the abdominal imaging fellowship program at Duke University Medical Center in Durham, N.C.

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