38 Chapter 3 Methods This study concerns a retrospective analysis of the outcomes of an international virtual training course focused on MRI of rectal cancer. Course participants provided informed consent to analyze their data as part of this study. The institutional review board of the principal investigating center approved use of the anonymized patient data included in this study and patient informed consent was waived. Course participants and faculty This virtual training course was designed by the authors and hosted by the European Society of Gastrointestinal and Abdominal Radiology (ESGAR). Sixty-five radiologists from 24 countries participated. The course faculty consisted of seven expert radiologists (RB-T, DL, ML, MM, RD, SN, LC-S; each with 10-25+ years of experience in clinical rectal MR imaging, rectal imaging research and education), one dedicated colorectal surgeon (GB; with >25 years’ experience in colorectal surgery) and one radiation oncologist specialized in GI oncology (BvT; > 20 years’ experience in rectal cancer treatment). Virtual training platform (iScore) and teaching materials For this virtual training course a dedicated web-based training platform (iScore) was used that was designed by two of the authors (NEK; DL). iScore combines the Open Health Imaging Foundation (OHIF) DICOM viewing platform [6] with customizable electronic case report forms (eCRFs) and links to online teaching resources. For this course, the structured reporting templates for rectal cancer MRI (re)staging published by ESGAR were converted into eCRFs and embedded into iScore [7]. For each staging item, a link to a 3-9 minute video-lecture was included (12 lectures in total), offering the participants background information and specific staging instructions provided by one of the experts from the faculty. Hyperlinks to relevant background literature [7–12] and educational resources [13, 14] were also included. A visual overview demonstrating the course setup is provided in Supplement 1. Case database and online feedback The case database comprised the MRIs of seven test-cases (five primary staging; two restaging after neoadjuvant treatment) and 70 training cases (40 primary staging, 20 restaging, 10 follow-up during organ-preservation) that were derived from a previous postgraduate teaching program. Both the test and training cases were selected so that they would offer a clinically representative sample in terms of for example T- and N-stage, mesorectal fascia (MRF) involvement and extramural vascular invasion (EMVI). For each of the 70 training cases, online feedback forms were constructed. These included the staging templates completed in consensus by two of the expert faculty members (a third reader was consulted to reach consensus in case of any disagreement), accompanied by annotated key images showing the most relevant staging pearls and pitfalls.
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