A Clinical Audit in West DenmarkEn klinisk audit i Region Midt- og Nordjylland
Background: Pelvic magnetic resonance imaging in patients with rectal cancer is an accepted tool for the identification of patients with poor prognostic tumours who may benefit from neo-adjuvant therapy. In Denmark, the examination has been mandatory in the work-up on rectal cancer since 2002. Objective: 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: Interventional, observational study. Two expert reviewers served as reference standard in the evaluation of consecutively performed pelvic MRI scans against which the evaluations from the participating centres were compared. Settings: Five imaging centres in West Denmark performing 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: 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 chemo-irradiation based on imaging findings pre- and post-course. Results: Eighteen percent of the scans were of satisfying technical quality for staging rectal cancer before the course compared to 74 % after (p< 0.001). After the course, the T-stage sub classification, depth of extra mural spread, N-stage and 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 centres. Conclusions: Performance and reporting of pelvic MRI in rectal cancer patients can be improved significantly through multidisciplinary development courses and on-site-visits while improvements in image interpretation with regard to treatment stratification may demand more intensive efforts.
Diseases of the Colon and Rectum, 2011, Vol 54, Issue 3, p. 328-334