{
  "abstract": "Objectives: Precise lesion localisation on prostate MRI—specifically, identification of whether at the apex, mid-gland, or base—is essential for effective communication and clinical management. This study aimed to assess interobserver agreement of current practice using the Prostate Imaging-Reporting and Data System (PI-RADS) against a novel anatomy-based approach, P-SMART (Prostate Simplified MRI Anatomy Recognition and Training).\n\nMaterials and methods: This multi-reader, two-phase agreement study, used axial and sagittal T2-weighted MRI from a publicly available dataset. Forty MRI cases were annotated with four regions of interest (ROIs). Readers were asked to document ROI location—apex, mid-gland, or base—first using the PI-RADS method, then following a 3-week washout period and short educational intervention, using the P-SMART method. Interobserver agreement was evaluated using Fleiss’ kappa (κ) statistics and compared following bootstrap resampling using a paired t -test. Subgroup analyses were performed by reader expertise and prostate size.\n\nResults: Following quality assurance, 156 ROIs were evaluated by 43 readers in each phase of the study. Overall interobserver agreement improved with P-SMART vs PI-RADS (κ = 0.571 vs 0.399; p < 0.001). In subgroup analyses, improvements were consistent for experts (0.663 vs 0.435; p < 0.001), non-experts (0.530 vs 0.393; p < 0.001), large prostates (0.518 vs 0.325; p < 0.001), and small prostates (0.620 vs 0.461; p < 0.001).\n\nConclusion: The P-SMART approach, designed to align with the PI-RADS sector map, yielded significantly higher interobserver agreement for prostate lesion-level localisation than the PI-RADS method, across reader experience and gland size, though overall agreement was only moderate. Improved reproducibility may support biopsy targeting, active surveillance monitoring, and treatment planning.\n\nKey Points: Question Can a novel method of dividing the prostate into apex, mid-gland, and base improve reader agreement compared to current practice?\n\nFindings The P-SMART method to divide the prostate outperformed PI-RADS (Fleiss’ kappa 0.571 vs 0.399), improving consistency across experience levels and prostate sizes.\n\nRelevance statement : More reproducible prostate level assignment supports accurate lesion localisation for biopsy planning, active surveillance, and treatment planning. If validated, P-SMART may improve communication and could be integrated into reporting workflows and software tools.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": null,
  "arxiv": null,
  "author_total": 57,
  "authors": [
    {
      "name": "Samuel J. Withey"
    },
    {
      "name": "Patricia Gutierrez"
    },
    {
      "name": "Alfonso M. Ponsiglione"
    },
    {
      "name": "Arnaldo Stanzione"
    },
    {
      "name": "Jeries P. Zawaideh"
    },
    {
      "name": "Giorgio Brembilla"
    },
    {
      "name": "Giacomo Avesani"
    },
    {
      "name": "Charlie A. Hamm",
      "orcid": "0000-0003-4104-4758"
    },
    {
      "name": "Adriano B. Dias"
    },
    {
      "name": "Sungmin Woo"
    },
    {
      "name": "Anwar R. Padhani"
    },
    {
      "name": "Vibeke Løgager"
    },
    {
      "name": "Andrea Ponsiglione"
    },
    {
      "name": "P-SMART Collaborators"
    },
    {
      "name": "Jorge Abreu-Gomez"
    },
    {
      "name": "Georgios Agrotis"
    },
    {
      "name": "Francesco Alessandrino"
    },
    {
      "name": "Fahd Alkhalifah"
    },
    {
      "name": "Yuki Arita"
    },
    {
      "name": "Aishah Azam"
    },
    {
      "name": "Tristan Barrett"
    },
    {
      "name": "Mariem Bensalah-Faria"
    },
    {
      "name": "Rodrigo Borrero-Leon"
    },
    {
      "name": "Silvia Bottazzi"
    },
    {
      "name": "Donato Bressi"
    },
    {
      "name": "Iztok Caglic"
    },
    {
      "name": "Charlotte Charbel"
    },
    {
      "name": "Emil Colliander"
    },
    {
      "name": "Renato Cuocolo"
    },
    {
      "name": "Maarten De Rooij"
    },
    {
      "name": "Nando De Vulder"
    },
    {
      "name": "Margot Delrue"
    },
    {
      "name": "Sofia A. N. Fialho"
    },
    {
      "name": "Maria G. Freda"
    },
    {
      "name": "Matilde L. R. R. Gonçalves"
    },
    {
      "name": "Jonathan Hernández-Mancera"
    },
    {
      "name": "Ilias Karvounis"
    },
    {
      "name": "Iman Kiani"
    },
    {
      "name": "Fredrik Langkilde"
    },
    {
      "name": "Nicolas A. Litardo"
    },
    {
      "name": "Ashley Luckyram"
    },
    {
      "name": "Luigi Mannacio"
    },
    {
      "name": "Ricardo S. Martins"
    },
    {
      "name": "Sandra P. Mazzini"
    },
    {
      "name": "Ana Sofia L. Moreira"
    },
    {
      "name": "Shakiba Mosadegh"
    },
    {
      "name": "Jina Pakpoor"
    },
    {
      "name": "Pavel Radu"
    },
    {
      "name": "Giorgio Raia"
    },
    {
      "name": "Guillaume Ramette"
    },
    {
      "name": "Luca Russo"
    },
    {
      "name": "Daniel A. Sandoval"
    },
    {
      "name": "Alicia R. Silberbrandt"
    },
    {
      "name": "William Weston"
    },
    {
      "name": "Chen Jiang Wu"
    },
    {
      "name": "Lili Xu"
    },
    {
      "name": "Yu Hang Yang"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/2jj7yaef340zx.bib",
  "cited_by": 0,
  "doi": "10.1186/s13244-026-02459-2",
  "fulltext_url": null,
  "id": "2jj7yaef340zx",
  "issns": [
    "1869-4101"
  ],
  "landing_url": "https://link.springer.com/article/10.1186/s13244-026-02459-2",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0",
  "metadata_licence": null,
  "native_subjects": [],
  "openalex": null,
  "pdf_url": "https://link.springer.com/content/pdf/10.1186/s13244-026-02459-2.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-05",
  "publisher": "Springer Science and Business Media LLC",
  "ris": "https://research.draconitic.com/paper/2jj7yaef340zx.ris",
  "sources": [
    {
      "first_seen": "2026-11-05T12:21:33Z",
      "native_id": "10.1186/s13244-026-02459-2",
      "source": "crossref",
      "url": "https://link.springer.com/article/10.1186/s13244-026-02459-2"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:1869-4101",
      "subfield": "imaging"
    }
  ],
  "title": "Prostate: simplified MRI anatomy recognition and training—the P-SMART study: a novel approach to defining prostatic apex, mid-gland and base",
  "title_text": "Prostate: simplified MRI anatomy recognition and training—the P-SMART study: a novel approach to defining prostatic apex, mid-gland and base",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T00:21:27Z",
  "url": "https://research.draconitic.com/paper/2jj7yaef340zx",
  "venue": "Insights into Imaging",
  "versions": []
}