Prostate Imaging Quality System Version 2 – A Practical Guide

High-quality prostate magnetic resonance imaging (MRI) is required for accurate prostate cancer detection, localization, and staging. Variability in image quality exists in practice, influenced by inconsistent adherence to technical standards, lack of patient preparation, variability in scanner performance, patient characteristics, and knowledge gaps in personnel scheduling and performing prostate MRI exams. The Prostate Imaging Quality (PI-QUAL) scoring system is a well-established tool for assessing the diagnostic quality of prostate MRI. An updated PI-QUAL version 2 was published in 2024 by a group of experts to address the limitations of the original system. This pictorial review highlights the key changes introduced in PI-QUAL version 2 and provides illustrative examples of each assessment category.