159 A Scientific impact (and therefore the importance of dedicated radiologist teaching and training) was also shown in Chapters 5 and 6, where reader experience had a significant impact on diagnostic performance and interobserver agreement. The results of Chapters 5-7 offer valuable guidance (in particular for less-experienced radiologists) on how to best assess and predict response to CRT, and on the added value of high-quality MRI acquisition protocols including DWI. Target population Our research findings are not only relevant to radiologists who perform rectal cancer staging, but also to other clinicians including surgeons, radiation oncologists, medical oncologists, and pathologists, who play a role in the management of rectal cancer. With the development of the iScore web-application, we present and efficient method to perform international diagnostic validation (and implementation) studies, which is relevant to the broader diagnostic research community. In addition to research applications, we have shown that iScore is also a highly valuable tool to be used for educational purposes. Activities The findings of this thesis have been widely disseminated through peer-reviewed publications and presentations at international conferences. The findings and recommendations related to rectal cancer imaging have also been disseminated via (online) radiological and clinical teaching course and workshops. These findings may furthermore serve as a basis for future guideline and template updates. The iScore webapplication that was developed as part of this thesis is still actively used as a tool for further validation and implementation research, not only in colorectal cancer but also in other disease entities including ovarian, breast and prostate cancer (via a follow-up project funded by the Dutch Cancer Society). The use of iScore as a tool for online education is also continued via ongoing collaborations with the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), as well as for teaching and training of residents and visiting fellows within the Netherlands Cancer Institute.
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