title: Estimation in medical imaging without a gold standard.
abstract: OBJECTIVE
  In medical imaging, physicians often estimate a parameter of interest (eg, cardiac ejection fraction) for a patient to assist in establishing a diagnosis. Many different estimation methods may exist, but rarely can one be considered a gold standard. Therefore, evaluation and comparison of different estimation methods are difficult. The purpose of this study was to examine a method of evaluating different estimation methods without use of a gold standard.
  
  
  METHODS
  This method is equivalent to fitting regression lines without the x axis. To use this method, multiple estimates of the clinical parameter of interest for each patient of a given population were needed. The authors assumed the statistical distribution for the true values of the clinical parameter of interest was a member of a given family of parameterized distributions. Furthermore, they assumed a statistical model relating the clinical parameter to the estimates of its value. Using these assumptions and observed data, they estimated the model parameters and the parameters characterizing the distribution of the clinical parameter.
  
  
  RESULTS
  The authors applied the method to simulated cardiac ejection fraction data with varying numbers of patients, numbers of modalities, and levels of noise. They also tested the method on both linear and nonlinear models and characterized the performance of this method compared to that of conventional regression analysis by using x-axis information. Results indicate that the method follows trends similar to that of conventional regression analysis as patients and noise vary, although conventional regression analysis outperforms the method presented because it uses the gold standard which the authors assume is unavailable.
  
  
  CONCLUSIONS
  The method accurately estimates model parameters. These estimates can be used to rank the systems for a given estimation task.
authors.affiliation: Department of Radiology, Arizona Health Sciences Center, Tucson 85724-5067, USA.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Kupinski
authors.forename: John W
authors.initials: JW
authors.lastname: Hoppin
authors.forename: Eric
authors.initials: E
authors.lastname: Clarkson
authors.forename: Harrison H
authors.initials: HH
authors.lastname: Barrett
authors.forename: George A
authors.initials: GA
authors.lastname: Kastis
mesh_terms: D003952:Diagnostic Imaging / Q000592:standards; D005069:Evaluation Studies as Topic; D006801:Humans; D016014:Linear Models; D015233:Models, Statistical; D015588:Observer Variation; D013318:Stroke Volume