Grey Areas: Imaging Terminology and Reporting

Fig. 1 – Bland-Altman plot(difference vs mean) showing a lack of PIRADS score reproducibility for two different mpMRI examinations of the same person at the same time. There is no correlation between the two mpMRI interpretations, with random upscoring and downscoring. The confidence interval is W 2 for a scale from 0 to 5. PI-RADS= Prostate Imaging Reporting and Data System; mpMRI = multiparametric magnetic resonance imaging. The naming and reporting of imaging procedures in the medical environment does not follow any standardised rules so far [1]. The reason for this is that the development and clinical integration of imaging techniques involve contributions from investigators and clinicians from varied backgrounds, including physics, engineering, and informatics, among others [2,3]. Each specialty has its own jargon, a specialised language that allows for rapid and efficient communication in a peer groupwhile minimising the potential for misunderstandings. Abbreviations enable health care professionals to document their work more easily and to communicate quickly, and are an extension of the jargon[4]. In particular, abbreviations have generally been adopted locally on an ad hoc basis to accommodate a lack of time and space, especially in documentation [5]. However, this often leads to the problem of several terms for the same object or generalisation, and some abbreviations might only be understood in the context they are used. In addition, there is a lack of standardisation and validation in reporting of imaging findings. As an example of this dilemma, the Prostate Imaging Reporting and Data System( PI-RADS) score for multiparametric magnetic resonance imaging (mpMRI) was never validated in multicentre studies before its general use [6]. Furthermore, critical parts of the scoring system have been modified, creating a grey zone in interpreting literature according to version I or version II. Moreover, interreader variability, reflecting differences in interpretation ( PI-RADSscore) by different radiologists for one mpMRI scan or for a second mpMRI scan taken at the same time for the same patient, is an issue. In a Norwegian study, two mpMRI evaluations were performed before biopsy, one for diagnostic reasons at one institution and one for practical reasonsat the time of fusion biopsy of the prostate at a second clinic. The two PI-RADS