Radiological Physics and Technology

, Volume 1, Issue 1, pp 2-12

First online:

ROC analysis in medical imaging: a tutorial review of the literature

  • Charles E. MetzAffiliated withRadiology and Medical Physics, The University of Chicago Email author 

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access


Receiver operating characteristic (ROC) analysis measures the “diagnostic accuracy” of a medical imaging system, which represents the second level of diagnostic efficacy in the hierarchical model described by Fryback and Thornbury (Med Decis Making 11:88–94, 1991). After describing the historical origins of ROC analysis, this paper reviews the importance of sampling cases appropriately, designing an observer study to avoid bias, and collecting data on a useful scale. A variety of methods for fitting ROC curves to observer data and testing the statistical significance of apparent differences are then reported. Finally, generalized forms of ROC analysis that require lesion localization or allow more than two states of truth are surveyed briefly.


Receiver operating characteristic analysis ROC analysis Image evaluation Diagnostic accuracy Diagnostic efficacy Observer performance