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Radiology. 2004 Dec;233(3):799-805. Epub 2004 Oct 14.

Detection of lung cancer on radiographs: receiver operating characteristic analyses of radiologists', pulmonologists', and anesthesiologists' performance.

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Departments of Radiology and Public Health, HĂ´pital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75012 Paris, France.



To compare and quantify, by means of receiver operating characteristic (ROC) and localization ROC analyses, the performance of radiologists, pulmonologists, and anesthesiologists (residents and staff) in the detection of missed lung cancer.


The study was approved by the institutional review board, and informed consent was not required or obtained for review of radiographs. A set of 60 posteroanterior chest radiographs was presented to 36 observers: 12 radiologists, 12 pulmonologists, and 12 anesthesiologists. Each of these three observer categories included six residents and six staff. Thirty of the radiographs each depicted one lung cancer that was overlooked at prospective image interpretation; the other 30 were normal radiographs matched for age and smoking history. Observers were asked to rate their degree of suspicion concerning the presence of lung cancer by using a visual analog scale and to point out the zone of suspicion on a schematic of the lung. These data were used to generate combined ROC-localization ROC curves and to assess performance. Intraobserver consistency was evaluated by using intraclass correlation coefficients and weighted kappa statistics.


Areas under the ROC curves indicated better performance for radiologists and pulmonologists compared with anesthesiologists (P < .002) and for staff compared with residents (P < .022). Performance was lower for all categories of observers when localization ROC curves were used. Radiologists and staff pulmonologists showed a higher degree of confidence in the assessment of normality than did other categories of physicians. Intraobserver consistency was poor.


Experienced readers showed better ability to distinguish normality from abnormality. Combined ROC and localization ROC analyses gave a more reliable quantification of observer performance than did ROC analysis alone.

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