Improving membranous urethral length measurements on prostate MRI: a comparison of online training methods

OBJECTIVES: This study compared three online training methods to enhance diagnostic performance, reader confidence, and interreader agreement in membranous urethral length (MUL) measurements. MATERIALS AND METHODS: Ninety-nine study participants were asked to measure the MUL on 20 test cases at the start of the study and rated their confidence level. Participants were then divided semi-randomly into three training groups: Group A (written instructions), Group B (1-month self-study program with case feedback using a dedicated web platform), and Group C (1-day online expert-led case-based training). Groups B and C worked through an identical set of 40 cases. One week after completing training, participants evaluated the same 20 test cases. Diagnostic performance (using expert reference standard), interreader agreement (intraclass correlation coefficient, ICC), and reader confidence levels were compared before and after training. Participants completed a questionnaire evaluating their perceptions of the training. RESULTS: Eighty-one participants (82%) completed the study. All groups demonstrated significant improvements in diagnostic performance and confidence (p < 0.001), with similar outcomes across training groups. Interreader agreement improved from ICC 0.52-0.56 pre-training to 0.74-0.80 post-training. Questionnaire responses indicated most found the training appropriate; however, 17% of Group A felt it was insufficient, while 30-35% of Group C found the expert-led training too time-consuming. CONCLUSION: All training methods-ranging from minimal, with written instructions only, to more comprehensive case-based programs-effectively improved diagnostic performance, reader confidence and interreader agreement for MUL measurements on prostate MRI. Independent online training offers practical advantages over more time-demanding hands-on sessions, supporting broader clinical implementation of MUL-based individualized continence prediction. KEY POINTS: Question Which method of online training is most effective to train radiologists in measuring the membranous urethral length (MUL) on prostate MRI? Findings 81 radiologists showed significant gains in diagnostic performance, confidence and interreader agreement, with similar results after written instructions, case-based self-study, or hands-on expert-led training. Clinical relevance Enhanced accuracy and interreader consistency achieved through online training can facilitate wider clinical adoption of MUL-based continence prediction, strengthening patient counseling and shared decision making in prostate cancer management.

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Publication Details

Journal
European Radiology
Published
2026-03-31
DOI
https://doi.org/10.1007/s00330-026-12468-w
Primary Topic
Prostate Cancer Diagnosis and Treatment
Type
article
Field-Weighted Citation Impact
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article

Improving membranous urethral length measurements on prostate MRI: a comparison of online training methods

Georgios Agrotis, Marta Duczkowska, Giuseppe Costanzo, Remco C. Baerveldt et al.
European Radiology
Prostate Cancer Diagnosis and Treatment
article

Improving membranous urethral length measurements on prostate MRI: a comparison of online training methods

Georgios Agrotis, Marta Duczkowska, Giuseppe Costanzo, Remco C. Baerveldt, Caterina Gaudiano, Manca Garbajs, Samuel J. Withey, Donna Zhan Chen, Giacomo Avesani, Alejandra García-Baizán, Stijn W. T. P. J. Heijmink, Paolo Niccolò Franco, Selahattin Durmaz, Cindy Mai, Tristan Barrett, Steven F. de Walle, Anil Kumar Geetha Virupakshappa, Emilie A. M. Weimar, Benedetta Masci, Patricia María José Manganaro, Valerio Forte, Jonathan Hernández, Giorgio Brembilla, Paul van Westerveld, Remy W. F. Geenen, Thierry N. Boellaard, Suzanne J. M. Tol, Inne Somers, Annemarie Bruining, Nicolae Vainak, Miha Vesel, Jorrit Noordmans, Bart W. K. de Wit, R. Girometti, Sabrina de Mello Ando, Joost J. M. van Griethuysen, Sandra Vennix, Amreen Shakur, Jorge Ocantos, Rogier S. A. van Stiphout, Carolien Kobus, Eline Hanrath-Vos, Arjuna Somasundaram, Renaud Tissier, Marinus J. Hagens, Geerard L. Beets, Verena Carola Obmann, Rinze Reinhard, Bas-Jeroen van Kelckhoven, José Carlos García-Gil García, Evşen Polattaş Solak, Niek van Oorschot, M.M. Silva, Eduardo Alvarez-Hornia, Mariliis Tiidermann, Luigi Mannacio, Lex J Schouten, Thijs R. van Oudheusden, Ruth Smit, Elisabeth P Goedegebuure, H. P. J. Frank Raat, Doenja M. J. Lambregts, Mariano Lorea, Joost Nederend, M. Zerunian, Ana Sofia L. Moreira, Hanna Falińska, Alout Ramselaar, Katarina Kaja Šifer, Pieter De Visschere, Ivo G. Schoots, Iris Minis-Rutten, on behalf of the Membranous Urethral Length – Training and Interpretation (MUL-TI READ) collaborative, Arnaldo Stanzione, Vuk Matic, Milton Josué Tapia Proaño, Rafael Salvador Izquierdo, Renato Cuocolo, Huseyin Kasap, Kang-Lung Lee, Yuki Arita, Ali Çağlar Turgut, Carolina Terra, Iztok Caglic, Matilde L. R. R. Gonçalves, Margriet C. van Dijk-de Haan, Artem Khmelinkskii, Maureen E. Groote, Andrea Ponsiglione, Eric Verhoeff, Radin-Darius Onit, Stephan Ursprung, Marianne J. Voogt
article en

Abstract

OBJECTIVES: This study compared three online training methods to enhance diagnostic performance, reader confidence, and interreader agreement in membranous urethral length (MUL) measurements. MATERIALS AND METHODS: Ninety-nine study participants were asked to measure the MUL on 20 test cases at the start of the study and rated their confidence level. Participants were then divided semi-randomly into three training groups: Group A (written instructions), Group B (1-month self-study program with case feedback using a dedicated web platform), and Group C (1-day online expert-led case-based training). Groups B and C worked through an identical set of 40 cases. One week after completing training, participants evaluated the same 20 test cases. Diagnostic performance (using expert reference standard), interreader agreement (intraclass correlation coefficient, ICC), and reader confidence levels were compared before and after training. Participants completed a questionnaire evaluating their perceptions of the training. RESULTS: Eighty-one participants (82%) completed the study. All groups demonstrated significant improvements in diagnostic performance and confidence (p < 0.001), with similar outcomes across training groups. Interreader agreement improved from ICC 0.52-0.56 pre-training to 0.74-0.80 post-training. Questionnaire responses indicated most found the training appropriate; however, 17% of Group A felt it was insufficient, while 30-35% of Group C found the expert-led training too time-consuming. CONCLUSION: All training methods-ranging from minimal, with written instructions only, to more comprehensive case-based programs-effectively improved diagnostic performance, reader confidence and interreader agreement for MUL measurements on prostate MRI. Independent online training offers practical advantages over more time-demanding hands-on sessions, supporting broader clinical implementation of MUL-based individualized continence prediction. KEY POINTS: Question Which method of online training is most effective to train radiologists in measuring the membranous urethral length (MUL) on prostate MRI? Findings 81 radiologists showed significant gains in diagnostic performance, confidence and interreader agreement, with similar results after written instructions, case-based self-study, or hands-on expert-led training. Clinical relevance Enhanced accuracy and interreader consistency achieved through online training can facilitate wider clinical adoption of MUL-based continence prediction, strengthening patient counseling and shared decision making in prostate cancer management.

European Radiology
Griffith University (AU), University of Bern (CH), National Academy of Medicine (US), University of Udine (IT), University of Salerno (IT), Royal Marsden NHS Foundation Trust (GB), Memorial Sloan Kettering Cancer Center (US), University College London Hospitals NHS Foundation Trust (GB), Universidad de Deusto (ES), Radboud University Nijmegen (NL), National Yang Ming Chiao Tung University (TW), Vita-Salute San Raffaele University (IT), Technical University of Cluj-Napoca (RO), University of California, San Francisco (US), Universidade do Porto (PT), Keio University (JP), University of Cambridge (GB), Royal Brisbane and Women's Hospital (AU), University Hospital of Bern (CH), Ghent University Hospital (BE), Catharina Ziekenhuis (NL), Erasmus MC (NL), Tartu University Hospital (EE), University Hospital Complex Of Vigo (ES), Hospital Italiano de Buenos Aires (AR), Cambridge University Hospitals NHS Foundation Trust (GB), Agostino Gemelli University Polyclinic (IT), Rigshospitalet (DK), State Hospital (GB), Taipei Veterans General Hospital (TW), The Netherlands Cancer Institute (NL), University Medical Center Utrecht (NL), Maastricht University (NL), Ege University (TR), Sint Franciscus Gasthuis (NL), Noordwest Ziekenhuisgroep (NL), Slingeland Ziekenhuis (NL), Zug Cantonal Hospital (CH), Reinier de Graaf Hospital (NL), Spaarne Ziekenhuis (NL), Antwerp University Hospital (BE), Ospedale San Carlo (IT), OLVG (NL), Administração Regional de Saúde de Lisboa e Vale do Tejo (PT), Affidea (CH), Azienda Ospedaliera San Gerardo (IT), Oncode Institute (NL), Elkerliek Ziekenhuis (NL), Hospital Clínic de Barcelona (ES), Ospedale Santa Maria (IT), Azienda USL di Bologna (IT), Algarve Biomedical Center (PT), Azienda Ospedaliera Sant'Andrea (IT), University Children's Hospital Tübingen (DE), Ospedale Santa Maria della Misericordia di Udine (IT), Hospital Universitario de La Princesa (ES), University Clinical Centre Maribor (SI), IRCCS Ospedale San Raffaele (IT), Bedford Hospital NHS Trust (GB), Hospital Universitário da Universidade de São Paulo (BR), Puigvert Foundation (ES), Gaziosmanpaşa Taksim Eğitim ve Araştırma Hastanesi (TR), Ziekenhuis Amstelland (NL), Elisabeth-TweeSteden Ziekenhuis (NL), Amsterdam University Medical Centers (NL), Laurentius Ziekenhuis (NL), Carlo Forlanini Hospital (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Ziekenhuis Bernhoven (NL), Meander Medisch Centrum (NL), Maastro Clinic (NL), Hospital São Paulo (BR), Spaarne Gasthuis (NL), Spitalul Clinic Județean de Urgență Cluj-Napoca (RO), University College London (GB), University of Naples Federico II (IT), University of Algarve (PT), Universitat de Barcelona (ES), University of Tübingen (DE)
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Prostate Cancer Diagnosis and Treatment
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