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For the aggregate performance of a technology, it is appropriate to determine the ROC curve for the technology. The ROC method takes into account the variability due to subjective interpretations of the image. Some of the comments this morning referred to the tradeoff between sensitivity and specificity. That may be true if you are talking about a technology in aggregate, because you will move up or down the ROC curve. It need not be the case for a single radiologist, however. I think there were some comments this morning that suggested some confusion about that: that if a radiologist increased his or her sensitivity, there would inevitably be loss of specificity. An individual can improve both sensitivity and specificity by moving to a different curve, because an individual does not necessarily have to move on the same curve.

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