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Measuring Performance in Chest Radiography¹

¹ From the Department of Radiology, Michigan State University, 164 Radiology Bldg, East Lansing, MI 48824. Received July 6, 1999; revision requested August 9; final revision received February 17, 2000; accepted February 23. Address correspondence to E.J.P. (e-mail: ejp@rad.msu.edu).

PURPOSE: To use a standardized set of chest radiographs to quantify interobserver differences and to provide a basis for comparing the diagnostic performance of physicians.

MATERIALS AND METHODS: A standardized set of 60 chest radiographs was presented to 162 study participants. Each participant reviewed the radiographs and recorded his or her diagnostic impression by using a fixed five-point scale. These response data were used to generate receiver operating characteristic curves and to establish performance benchmarks. The variations in performance were tested for statistical significance.

RESULTS: Significant interobserver variability was identified during these assessments. The composite group of board-certified radiologists demonstrated performance superior to that of the radiology residents and nonradiologist physicians.

CONCLUSION: By using a receiver operating characteristic approach and a standardized set of chest radiographs, observer accuracy and variability are easily quantified. This approach provides a basis for comparing the diagnostic performance of physicians. When value is measured as a diminution in uncertainty, board-certified radiologists contribute substantial value to the diagnostic imaging system.

Index terms: Diagnostic radiology, observer performance • Receiver operating characteristic (ROC) curve

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