28 Chapter 2 Tumour-MRF distance IOA (and agreement with the expert reference) to assess an involved MRF were high, but there was large variation in measuring the tumour-MRF distance with an IOA of only α=0.33 (two examples shown in Figure 5). Figure 5 Examples of two cases where there was substantial variation in tumour-MRF distance among readers. The upper row shows the sagittal (A) and transverse (B) images of a male patient with an upper rectal tumour, situated above the level of the anterior peritoneal reflection. Six out of 21 readers (29%) erroneously interpreted the anterior invasion of the peritoneum as MRF invasion and measured a tumourMRF distance of 0 mm, while other readers (and the expert reference) measured the distance from the tumour to dorsal MRF as > 10 mm. The bottom row (sagittal C, transverse D) shows a male patient with a mid-rectal tumour. Some readers interpreted the anterior rectal wall as involved, while other readers (and the expert reference) believed this tumour was confined to the left dorsolateral wall, resulting in a tumourMRF distance of >10 mm.
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