The aim of the trial is to understand whether a computerised tool designed to quickly spot problems in brain scans (MIDI) can help doctors diagnose cases faster. This will help patients by getting them the treatment they need sooner. How useful doctors find the tool will also be measured, and whether it is cost-saving for the National Health Service (NHS).

NHS radiology services are under unprecedented pressure as rising demand outpaces available workforce capacity. MRI utilisation across the NHS has increased by 9% year-on-year. As a result, many departments have relied on unsustainable measures such as outsourcing and weekend insourcing to manage reporting backlogs.

Delays in scan reporting have serious implications, including missed or delayed diagnoses, prolonged hospital stays, higher healthcare costs, and poorer patient outcomes. A systematic review and meta-analysis found that each month of delay in initiating cancer treatment increases mortality risk by approximately 10%.

There is an urgent need for validated digital tools that can reduce TATs without compromising diagnostic accuracy. The TRIAGE study (Triage Radiology Imaging Assessment for Greater Effectiveness (TRIAGE): a Cluster-Randomised Crossover Trial Evaluating the Reporting Turn-Around-Time of Brain Magnetic Resonance Images using an AI-enabled Abnormality Detector for Prioritisation) evaluates whether MIDI can reduce the average TAT of abnormal scans in routine NHS clinical practice.

The primary purpose of MIDI is workflow triage: it enables prioritisation of abnormal scans within radiology reporting worklists, helping departments manage high volumes efficiently.

Inclusion Criteria:

For main trial

• Adult patient (≥ 18 years of age) at the time of MRI.
• Brain MRI scan performed at a participating NHS site during the defined study period (intervention or control arm).
• Brain MRI scan series will automatically be included if they contain the required scan sequences and are of the required resolution.

For O3 subgroup ● Radiologists, radiographers, and referring clinicians involved with the use of the MIDI tool at sites who consent to completing the staff survey

For O7 subgroup

• Adult patient (≥ 18 years of age) at the time of MRI.
• Brain MRI scan performed at a participating NHS site during the defined study period (intervention or control arm).
• Brain MRI scan series will automatically be included if they contain the required scan sequences and are of the required resolution.
• Patient with suspected de novo stroke/TIA in TIA/Stroke pathway.
• Patient with suspected de novo stroke/TIA in Acute Neurology pathway.
• Patient with suspected de novo stroke/TIA identified via SSNAP review.

For O8 subgroup

• Adult patient (≥ 18 years of age) at the time of MRI.
• Brain MRI scan performed at a participating NHS site during the defined study period (intervention or control arm).
• Brain MRI scan series will automatically be included if they contain the required scan sequences and are of the required resolution.
• Patient with stage III/IV malignant melanoma undergoing regular surveillance MRI brain scans presenting with de novo brain metastases.
• Patient with lung cancer undergoing pre-radical treatment staging MRI brain scans presenting with de novo brain metastases.
• Patients with de novo symptomatic brain metastases secondary to melanoma and/or lung cancer and/or breast cancer detected on MRI brain scans from all patient pathways.

Additionally for those completing EORTC questionnaires:

● Able to give consent and likely to be able to complete EORTC questionnaires.

Exclusion Criteria:

For main trial

• Patient is under 18 years of age at the time of MRI.
• Brain MRI scan not performed at a participating NHS site or outside the defined study period.
• Data will be excluded for those patients who have opted out of the use of their data for research under the National Data Opt-Out.
• Brain MRI scan series will automatically be excluded if they do not contain the required scan sequences and/or the required resolution.

For O3 subgroup ● Radiologists, radiographers, and referring clinicians involved with the use of the MIDI tool at sites who do not consent to completing the staff survey

For O7 subgroup

• Patient is under 18 years of age at the time of MRI.
• Brain MRI scan not performed at a participating NHS site or outside the defined study period.
• Data will be excluded for those patients who have opted out of the use of their data for research under the National Data Opt-Out.
• Brain MRI scan series will automatically be excluded if they do not contain the required scan sequences and/or the required resolution.
• Patient without suspected de novo stroke/TIA or not on TIA/Stroke pathway.
• Patient without suspected de novo stroke/TIA or not on Acute Neurology pathway.

For O8 subgroup

• Patient is under 18 years of age at the time of MRI.
• Brain MRI scan not performed at a participating NHS site or outside the defined study period.
• Data will be excluded for those patients who have opted out of the use of their data for research under the National Data Opt-Out.
• Brain MRI scan series will automatically be excluded if they do not contain the required scan sequences and/or the required resolution.
• Patient without stage III/IV malignant melanoma, or not undergoing regular surveillance MRI brain scans, or not presenting with de novo brain metastases.
• Patient without lung cancer undergoing pre-radical treatment staging MRI brain scans, or not presenting with de novo brain metastases.
• Patients without de novo symptomatic brain metastases secondary to melanoma and/or lung cancer and/or breast cancer detected on MRI brain scans.

Additionally for those completing EORTC questionnaires:

● Unable to give consent and unlikely to be able to complete EORTC questionnaires.