Patient deprivation and perceived scan burden negatively impact on the quality of WB-MRI

Aim: To evaluate the association between cancer staging whole body WB-MRI (WB-MRI) image quality and patient demographics, distress and perceived scan burden Materials and Methods: A sample of patients prospectively recruited to multicentre trials comparing WB-MRI with standard scans for staging lung and colorectal cancer, were invited to complete two questionnaires. The baseline questionnaire, administered at recruitment, collated data on demographics, distress and co-morbidity; the follow-up questionnaire, completed after staging investigations, measured perceived WB-MRI scan burden (scored 1 low to 7 high). WB-MRI anatomical coverage and technical quality was graded by a radiographic technician and grading combined to categorise the scan as ‘optimal’, ‘sub-optimal’ or ‘degraded’. A radiologist categorised 30 scans to test inter-observer agreement. Data were analysed using Chi Square, Fisher Exact, t-tests and multinomial regression. Results: 114 patients were included in the study (53 lung, 61 colorectal; average age 65.3, SD=11.8; 66 men, (57.9%)). Overall, 45.6% (n=52), scans were classified as ‘optimal’ quality, 39.5% (n=45) ‘sub-optimal’ and 14.9% (n=17) as ‘degraded’. In adjusted analyses greater deprivation level and higher patient-reported scan burden were both associated with a higher likelihood of having a sub-optimal vs. an optimal scan (OR: 4.465, CI: 1.454 to 13.709, p=0.009; OR: 1.987, CI: 1.153 to 3.425, p=0.013 respectively). None of the variables predicted the likelihood of having a degraded scan. Conclusions: Deprivation as well as patients’ perceived experience of the WB-MRI, is related to image quality. Tailored protocols and individualised patient management before and during WB-MRI may improve scan quality

Patient preferences for whole-body MRI or conventional staging pathways in lung and colorectal cancer: a discrete choice experiment

Objectives To determine the importance placed by patients on attributes associated with whole-body MRI (WB-MRI) and standard cancer staging pathways and ascertain drivers of preference. Methods Patients recruited to two multi-centre diagnostic accuracy trials comparing WB-MRI with standard staging pathways in lung and colorectal cancer were invited to complete a discrete choice experiment (DCE), choosing between a series of alternate pathways in which 6 attributes (accuracy, time to diagnosis, scan duration, whole-body enclosure, radiation exposure, total scan number) were varied systematically. Data were analysed using a conditional logit regression model and marginal rates of substitution computed. The relative importance of each attribute and probabilities of choosing WB-MRI-based pathways were estimated. Results A total of 138 patients (mean age 65, 61% male, lung n = 72, colorectal n = 66) participated (May 2015 to September 2016). Lung cancer patients valued time to diagnosis most highly, followed by accuracy, radiation exposure, number of scans, and time in the scanner. Colorectal cancer patients valued accuracy most highly, followed by time to diagnosis, radiation exposure, and number of scans. Patients were willing to wait 0.29 (lung) and 0.45 (colorectal) weeks for a 1% increase in pathway accuracy. Patients preferred WB-MRI-based pathways (probability 0.64 [lung], 0.66 [colorectal]) if they were equivalent in accuracy, total scan number, and time to diagnosis compared with a standard staging pathway. Conclusions Staging pathways based on first-line WB-MRI are preferred by the majority of patients if they at least match standard pathways for diagnostic accuracy, time to diagnosis, and total scan number