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A survey of 12 studies of lung cancer detection with cancer prevalence ranging from 0.9 to 476 cancers per 1000 showed that the unit-slope index of detectability, d', decreased from a high value of 3.9 at low prevalence to 1.4 at high prevalence. A proposed explanation is that the readers are operating on an ROC curve with a slope that is less than unity approximating 0.6. On such a curve, a shift to more stringent criteria that occurs with decreasing prevalence in order to minimize false positives, would result in a increased unity- slope d'.
Harold L. Kundel
"Disease prevalence and the index of detectability: a survey of studies of lung cancer detection by chest radiography", Proc. SPIE 3981, Medical Imaging 2000: Image Perception and Performance, (14 April 2000); https://doi.org/10.1117/12.383100
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Harold L. Kundel, "Disease prevalence and the index of detectability: a survey of studies of lung cancer detection by chest radiography," Proc. SPIE 3981, Medical Imaging 2000: Image Perception and Performance, (14 April 2000); https://doi.org/10.1117/12.383100