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The aim of this study was therefore to assess the inter- and intra-operator reliability of manual segmentation of femoral metastatic lesions.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>CT scans of 54 metastatic femurs (19 osteolytic, 17 osteoblastic, and 18 mixed) were segmented two times by two operators. Dice coefficients (DCs) were calculated adopting the quantification that a DC\u02c30.7 indicates good reliability.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Generally, rather poor inter- and intra-operator reliability of lesion segmentation were found. Inter-operator DCs were 0.54 (\u00b1\u20090.28) and 0.50 (\u00b1\u20090.32) for the first and second segmentations, respectively, whereas intra-operator DCs were 0.56 (\u00b1\u20090.28) for operator I and 0.71 (\u00b1\u20090.23) for operator II. Larger lesions scored significantly higher DCs in comparison with smaller lesions. Of the femurs with larger mean segmentation volumes, 83% and 93% were segmented with good inter- and intra-operator DCs (&gt;\u20090.7), respectively. There was no difference between the mean DCs of osteolytic, osteoblastic, and mixed lesions.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Manual segmentation of femoral bone metastases is very challenging and resulted in unsatisfactory mean reliability values. There is a need for development of a segmentation protocol to reduce the inter- and intra-operator segmentation variation as the first step and use of computer-assisted segmentation tools as a second step as this study shows that manual segmentation of femoral metastatic lesions is highly challenging.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s11548-021-02450-w","type":"journal-article","created":{"date-parts":[[2021,7,15]],"date-time":"2021-07-15T20:02:21Z","timestamp":1626379341000},"page":"1841-1849","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Evaluation of inter- and intra-operator reliability of manual segmentation of femoral metastatic lesions"],"prefix":"10.1007","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7023-9138","authenticated-orcid":false,"given":"Ali","family":"Ataei","sequence":"first","affiliation":[]},{"given":"Florieke","family":"Eggermont","sequence":"additional","affiliation":[]},{"given":"Milan","family":"Baars","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9003-6124","authenticated-orcid":false,"given":"Yvette","family":"van der Linden","sequence":"additional","affiliation":[]},{"given":"Jacky","family":"de Rooy","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7531-6523","authenticated-orcid":false,"given":"Nico","family":"Verdonschot","sequence":"additional","affiliation":[]},{"given":"Esther","family":"Tanck","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2021,7,15]]},"reference":[{"issue":"S8","key":"2450_CR1","first-page":"1588","volume":"80","author":"RE Coleman","year":"1997","unstructured":"Coleman RE (1997) Skeletal complications of malignancy. 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