A Delphi consensus process was undertaken to formulate recommendations regarding three different areas in the diagnostic MRI pathway of PCa: (1) image quality assessment of mpMRI; (2) interpretation and reporting of mpMRI; and (3) reader experience and training requirements. The Delphi method is a technique of structured and systematic information gathering from experts on a specific topic using a series of questionnaires [13 (link)]. In this study, the diagnostic role of mpMRI in biopsy-naïve men with a suspicion of PCa was considered.
The Delphi process was carried out in four phases (Fig. 1). (1) Panellists from the European Society of Urogenital Radiology (ESUR) and EAU Section of Urologic Imaging (ESUI) were selected based on expertise and publication record in the PCa diagnosis, and on their involvement in guideline development. (2) A questionnaire was created with items that were identified by a subcommittee of the ESUR, based on the statements from a recent UK consensus paper on implementation of mpMRI for PCa detection [14 (link)]. (3) Panel-based consensus findings were determined using an online Delphi process. For this purpose, an internet survey was generated and sent by email to the members of the group (created in Google Forms). In the second round, a reminder to complete the questionnaires was sent by email. The panellists anonymously completed two rounds of a questionnaire consisting of 39 items (including 55 subquestions). Based on the knowledge of the entire group’s responses in the first round, second round voting was performed. Outcomes of the multiple-choice and open questions were graphically displayed, so the results could be reflected before selecting a response in the second round. For inclusion in the final recommendations, each survey item required to have reached group consensus by the end of the two survey rounds. (4) The items of the questionnaires were analysed, and consensus statements were formulated based on the outcomes. In total, 31 of 55 items were rated for agreement on a 9-point Likert scale.

Details of the stages of the Delphi process (flow chart)

An item scored as ‘agree’ (score 7–9) by ≥ 70% of participants and disagree (score 1–3) by ≤ 15% constituted ‘consensus agreement’ for an item. An item scored as ‘disagree’ (score 1–3) by ≥ 70% of participants and agree (score 7–9) by ≤ 15% was considered as ‘consensus disagreement’. The other items (24 of 55) were multiple-choice or open questions and were presented graphically. For the multiple-choice or open questions to reach consensus, a panel majority scoring of ≥ 50% was required.
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