46 Chapter 3 in accuracy for T-staging on MRI between an experienced gastrointestinal radiologist accuracy 88%) and a general radiologist (accuracy 68%)[15]. Our results for individual T-stage assessment were relatively poor (accuracy 62% both pre- and post-training) but results for dichotomized T-stage assessment (T0-3ab vs. T3cd-4) were much better with an accuracy of 95%; these results are in line with previous reports that also show significantly better results for dichotomized T-stage assessment [16, 17]. In a study focused on staging of lateral lymph nodes, Sluckin et al. showed that consistency in the anatomical classification and size measurements of these nodes improved for a group of 53 Dutch radiologists after online training sessions led by expert radiologists[2]. In another study by Wang et al. six months of targeted training on EMVI was shown to significantly increase the agreement of inexperienced radiologists with an expert reference, as well as the accordance with pathology. The latter study demonstrated a 20% increase in diagnostic performance (using an expert reference), similar to the 17% increase observed in our current study, after a shorter intervention time [3]. When looking at the different individual staging parameters assessed in this study, most evident effects on staging performance and IOA were observed for EMVI, tumour composition (solid vs mucinous), and for defining the tumour boundaries (i.e. measuring tumour height and length). Interestingly, in contrast with the known inaccuracies of MRI in assessing lymph nodes, results for nodal staging were relatively good with accuracies of 80% pre-course and 82% post-course. When comparing the baseline (pre-course) staging accuracy between participants with <5 versus ≥5 years of prior experience in reading rectal cancer MRI, our results showed a tendency towards a higher baseline accuracy with less effect of the course on staging performance for the more experienced participants, but due the limited number of cases most variables were not significant. The previously mentioned report by Bregendahl et al. showed that out of various components of teaching and training, hands-on individual feedback had the most significant impact on staging performance in a group of 18 radiologists and radiology registrars that participated in a dedicated onsite (face-to-face) training program. Their training program – like our virtual course –comprised of workshops, independent case-readings and individual feedback sessions[1]. In our current study we have shown that a similar positive effect as reported by the group of Bregendahl for their face-to-face training program may also be achieved via dedicated online training. In 2022 a working group from the UK Royal College of Radiologists (RCR) assessed and compared the advantages and disadvantages of online versus face-to-face teaching based on experiences prior to and during the COVID-19 lockdown. They concluded that the pandemic had a significant impact on radiology training, with much of the traditional face-to-face training being
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