Postgraduate Multidisciplinary Development Program: Impact on the Interpretation of Pelvic MRI in Patients With Rectal Cancer: A Clinical Audit in West Denmark

BACKGROUND: Pelvic MRI in patients with rectal cancer is an accepted tool for the identification of patients with poor prognostic tumors who may benefit from neoadjuvant therapy. In Denmark, this examination has been mandatory in the workup on rectal cancer since 2002. OBJECTIVE: This study aimed to assess the impact of a multidisciplinary team course for doctors in West Denmark on the technical quality, reporting, and interpretation of pelvic MRI in rectal cancer. DESIGN: This study is interventional and observational. Two expert reviewers served as reference standard in the evaluation of consecutively performed pelvic MRI scans against which the evaluations from the participating centers were compared. SETTINGS: Five imaging centers in West Denmark performed pelvic MRI in rectal cancer from March 1 to December 31, 2007. PATIENTS: One hundred and eighty patients with newly diagnosed rectal cancer were enrolled. INTERVENTIONS: This study involved a multidisciplinary team course including on-site visits. MAIN OUTCOME MEASURES: The MR scans were evaluated concerning technical performance, reporting, interpretation, and the ability to correctly allocate patients to chemoirradiation based on imaging findings pre- and postcourse. RESULTS: Eighteen percent of the scans were of satisfying technical quality for staging rectal cancer before the course compared with 74% after (P<.001). After the course, the T-stage subclassification, the depth of extramural spread, the N stage, and the presence of extramural vascular invasion was reported significantly more frequently. Based on imaging findings, we observed no significant effect on the ability to perform correct treatment stratification according to Danish guidelines. LIMITATIONS: The evaluation process itself may have improved the performance of the participating centers. CONCLUSIONS: Performance and reporting of pelvic MRI in patients with rectal cancer can be improved significantly through multidisciplinary development courses and on-site visits, whereas improvements in image interpretation with regard to treatment stratification may demand more intensive efforts.