Influence of Enema and Dietary Restrictions on Prostate MR Image Quality: A Multireader Study.

PURPOSE: To evaluate the effect of enema and dietary restrictions on prostate MR image quality metrics and to assess inter-reader agreement for these metrics. METHODS: This retrospective study included 195 men divided into groups based on their compliance with preparation instructions before prostate MRI (Enema + Diet, n = 98; Enema, n = 42; Diet, n = 35; Control [no compliance], n = 20). Four readers independently assessed six image quality metrics on a 5-point scale. Between-group comparisons were made using Wilcoxon rank sum test. Inter-reader agreement was calculated using Fleiss' kappa. RESULTS: Compared with the Control group, image quality with respect to rectal stool/gas, distortion of diffusion-weighted images, overall image quality, and confidence in assessment was higher in the Enema + Diet, Enema, and Diet groups (p  < 0.05 for all comparisons). The Enema + Diet and Enema groups had significantly higher scores than the Diet group for rectal stool/gas (p < 0.001 and 0.005, respectively). The Enema + Diet and Diet groups had higher scores than the Control group for rectal peristalsis (p = 0.027 and 0.009, respectively), but there were no significant differences in motion artifacts on T2-weighted images. Agreement among readers was fair, with kappa values ranging from 0.25 to 0.37. CONCLUSION: Enema and dietary restriction can improve the quality of prostate MRI by decreasing rectal distension and distortion of diffusion-weighted images and by increasing reader confidence in image assessment. Inter-reader agreement using subjective criteria for analysis of MRI quality is fair.

Fidelity of Electronic Documentation for Reactions Prompting Premedication to Iodinated Contrast Media.

PURPOSE: The aims of this study were to assess the fidelity of electronic health record documentation prompting premedication to iodinated contrast media and to determine the appropriateness of administered premedication on the basis of that documentation. METHODS: In this retrospective quality assurance cohort study, medication adverse events recorded in electronic health records between January 1, 2018, and August 31, 2019, to "iodine," "iodine-containing products," and "iodinated contrast media" were identified (N = 4,309); entries missing documentation (n = 1,651) and breakthrough reactions (n = 22) were excluded. Reaction description, severity, and free-text comments were used to categorize each entry as concordant (documentation matches recorded severity per the ACR Manual on Contrast Media version 10.3), discordant (description-severity mismatch, agent unrelated to iodinated contrast media, not a hypersensitivity reaction), or unclear. A subset of patients undergoing premedication was identified, and premedication was categorized as appropriate, inappropriate, or unsure on the basis of the index reaction using the aforementioned framework. Descriptive statistics were calculated. RESULTS: There were 2,636 adverse event entries in 2,441 patients: 59.9% (1,578 of 2,636) were classified as concordant, 30.2% (797 of 2,636) as discordant (n = 377 not a hypersensitivity reaction, n = 317 description-severity mismatch, and n = 103 unrelated agent), and 9.9% (n = 261) as unclear documentation. For the premedicated subset, concordance classification was feasible for 202 unique patients premedicated 335 times. Premedication was appropriate in 72% (240 of 335) and inappropriate in 22% (73 of 335); 17% of premedication events (56 of 335) were inappropriately administered for a prior physiologic reaction. CONCLUSIONS: Premedication prompts in the electronic health record are often erroneous because of inaccurate coding, incomplete data, and reaction misclassification. These errors result in inappropriate premedication for a substantial minority of patients.