Bootstrap-based procedures for inference in nonparametric ROC regression analysis

Before the use of a diagnostic test in a routine clinical setting, the rigorous evaluation of its diagnostic accuracy is an essential step. The receiver operating characteristic (ROC) curve is the measure of accuracy most widely used for continuous diagnostic tests. However, the possible impact of extra information about the patient (or even the environment) on diagnostic accuracy needs to be also assessed. In this paper, attention is focused on an estimator for the covariate-specific ROC curve based on direct regression modelling and nonparametric smoothing techniques. This approach defines the class of generalized additive models for the ROC curve (ROC-GAM). The main aim of the paper is to offer new inferential procedures for testing the effect of co- variates over the conditional ROC curve within the ROC-GAM context. Specifically, two different bootstrap-based tests are suggested to check (a) the possible effect of continuous covariates on the ROC curve; and (b) the presence of factor-by-curve interaction terms. The validity of the proposed bootstrap-based procedures is supported by simulations. To facilitate the application of these new procedures in practice, an R-package, known as npROCRegression, is provided and briefly described. Finally, data derived from a computed-aided diagnostic (CAD) system for the automatic detection of tumour masses in breast cancer is analysed

Bootstrap-based procedures for inference in nonparametric receiver-operating characteristic curve regression analysis

Prior to using a diagnostic test in a routine clinical setting, the rigorous evaluation of its diagnostic accuracy is essential. The receiver-operating characteristic curve is the measure of accuracy most widely used for continuous diagnostic tests. However, the possible impact of extra information about the patient (or even the environment) on diagnostic accuracy also needs to be assessed. In this paper, we focus on an estimator for the covariate-specific receiver-operating characteristic curve based on direct regression modelling and nonparametric smoothing techniques. This approach defines the class of generalised additive models for the receiver-operating characteristic curve. The main aim of the paper is to offer new inferential procedures for testing the effect of covariates on the conditional receiver-operating characteristic curve within the above-mentioned class. Specifically, two different bootstrap-based tests are suggested to check (a) the possible effect of continuous covariates on the receiver-operating characteristic curve and (b) the presence of factor-by-curve interaction terms. The validity of the proposed bootstrap-based procedures is supported by simulations. To facilitate the application of these new procedures in practice, an R-package, known as npROCRegression, is provided and briefly described. Finally, data derived from a computer-aided diagnostic system for the automatic detection of tumour masses in breast cancer is analyse

Digital radiography of the chest: state of the art

Digital image acquisition possesses a number of advantages over conventional systems in radiographic examination of the chest, the most important of which is its greater dynamic range. In addition, one digital images are acquired, they can be processed by computer in ways that cannot be rivalled by conventional analog techniques. Finally, digital images can be stored, retrieved and transmitted to local or remote sites. Here the status of the different digital systems employed in chest radiology and commonly used image processing techniques are reviewed. Also discussed are the current clinical applications of integrating digital chest radiography with a picture archiving and communication system (PACS) along with the difficulties typically encountered. Studies with a variety of digital techniques have been carried out on several fronts. Computer radiography based on photostimulabe phosphor (CR) has replaced screen-film imaging in certain applications (i.e. bedside imaging). However, CR has limitations, namely its poor X-ray utilisation efficiency at high X-ray tube voltages and sensitivity to scatter; therefore, it is not ideal for all applications. Recently, a dedicated digital chest unit with excellent X-ray utilisation efficiency at high X-ray tube potentials has been introduced. On the basis during the past decade, recommendations are made regarding the most desirable equipment specifications for dedicated and bedside digital chest radiography. © 1994 Springer-Verlag