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Radiology 2003—The Constancy of Change

Index terms: Editorials • Radiology (journal)

With the publication of the January 2003 issue of Radiology, I begin my 6th year as Editor. The first 5 years have passed quickly; it seems as if it was only yesterday that the January 1998 issue of the Journal was published. The RSNA Board of Directors has offered me the honor of continuing my service as Editor of Radiology, and I have accepted this unique opportunity to be exposed to the innovation and insights of the numerous authors who submit their work to us. My sincerest thanks are extended to the Board members for their support over the past 5 years, especially to R. Nick Bryan, MD, PhD, and Robert R. Hattery, MD, the former and current Board Liaisons overseeing the Journal. My sincerest thanks are extended as well to the Executive Director of the RSNA, Dave Fellers, CAE, and to the staff of the Richmond, Va, and Oak Brook, Ill, offices. Please see the first page of our Publication Information for Authors guidelines, appearing in this and every issue of Radiology, to learn the names of these many staff members whose expertise and dedication make the monthly issue of Radiology a reality.

Part of the excitement of being Editor of Radiology is the opportunity to share with our readers my thoughts reflecting my belief that improving our Journal and our profession requires constant, positive change.

Authorship
Authorship has been a topic of interest to me as Editor of Radiology (1–5). Others have also found it of interest and have published their thoughts and positions on the same (6–10). In the current issue of Radiology, the Special Reports section contains yet another publication (11) addressing this important topic. My compliments are extended to Dr Hwang and co-authors for the extensive analysis they performed on original research manuscripts having at least three authors and published in Radiology from January 1998 to December 2000. They have uncovered a number of interesting points regarding authors’ fulfillment of the International Committee of Medical Journal Editors (ICMJE) criteria for authorship, fulfillment based on the byline position of authors, the extent and nature of researcher contributions based on the specific categories used for Radiology, and the differences between American and international authors. In Materials and Methods in their article, they note that four papers were excluded in their analysis since "a name listed in the byline did not appear in the contribution list."

Dr Hwang and co-authors (11) were kind enough to identify these four papers for me. On looking into the matter, I learned that all four were published in the January and February 1998 issues of Radiology, at the very beginning of my tenure as Editor. While unhappy that this occurred, I was somewhat relieved to learn that these manuscripts appeared early in 1998. At the time, for several of the initial issues of the year 1998 we had to obtain author contribution listings after the manuscripts had already been accepted and sent for production to the RSNA Headquarters Office in Oak Brook (manuscripts are sent to Oak Brook several months in advance of the articles appearance in print). To the contrary, for manuscripts now submitted we require that the author contributions be listed before the manuscripts receive final acceptance and before they are sent for production.

Dr Hwang and co-authors (11) mention in their discussion that there may be misunderstanding or lack of awareness of the ICMJE criteria; that there is a need for education regarding authorship criteria; and that the awareness of authorship criteria has apparently not increased, because articles published in Radiology from 1998 to 2000 have shown "no substantial improvement of the fulfillment of authorship criteria" (11). I also believe that continued education and awareness of the ICMJE criteria are needed (1–7). Thus, while we have queried authors regarding their contributions and have listed these contributions, we have not, to date, mandated that all the ICMJE criteria be fulfilled by those who have been listed as authors in the submitted manuscripts. We applaud those individuals who have removed their names from the byline when we have queried them for their contributions and they have learned of the ICMJE criteria.

Why is it that many individuals list their names as authors when they do not meet these criteria? There are many possible reasons, as discussed by Dr Hwang and co-authors (11) and by other authors they have referenced. Is yet another reason the requirement for promotion in many academic centers—a focus on the number of peer-reviewed articles published? Does the "numbers game" in part prompt individuals to seek every opportunity for authorship, whether warranted or not? Perhaps if promotion committees focused (as some undoubtedly do) more on the quality of the published work and the contributions made by the authors than on the number of publications, the motivation to seek every opportunity to be listed as an author, even when unwarranted, would diminish. My comments should not be interpreted as an excuse for individuals to seek authorship when not warranted. Rather, my comments should be interpreted as an opportunity for medical school deans and promotion committees to help in the process of guiding the researchers in their institutions to a better recognition of what it means to be listed on the byline of an article as author. I hope that by publishing the contributions made by those listed as authors of manuscripts appearing in Radiology, we will better inform our readers as to what each individual has actually contributed to the study.

I urge all individuals who submit their manuscripts to Radiology to familiarize themselves with the ICMJE criteria for authorship. These are found in our Publication Information for Authors guidelines available in each printed issue of Radiology and in Radiology Online (radiology.rsnajnls.org). They can also be found at www.icmje.org/index/html.

We have been listing Author Contributions in Radiology beginning with my first issue as Editor in January 1998. By so doing and by requiring authors to identify their contributions, I believe that over the past 5 years authors have become aware that we are interested in the contributions of those who list themselves in the byline as authors. To further emphasize that interest, we are contemplating a change in our copyright form that will further underscore the ICMJE criteria for authorship.

STARD Report
Also found in the Special Reports section of the current issue of Radiology is a report from the Standards for Reporting of Diagnostic Accuracy (STARD) Group (12). I was privileged to participate in the activity of the STARD Group as a group member. The purpose of this undertaking was "to improve the quality of the reporting of diagnostic studies" (12). As pointed out by the authors, "New tests are developed at a fast rate and the technology of existing tests is continuously being improved. Exaggerated and biased results from poorly designed and reported diagnostic studies can trigger their premature dissemination and lead physicians into making incorrect treatment decisions" (12).

We ask authors who send us their research reports dealing with studies of diagnostic accuracy to familiarize themselves with the STARD publication, in particular the published checklist. Please follow this checklist when preparing your manuscript. Additional details and examples appear in a more extensive report in the January 2003 issue of Clinical Chemistry. Suggestions for improvements in the checklist should be sent to stard@amc.uva.nl. The editors of several journals that reach different readers have agreed to publish in January 2003 the checklist and/or report found in the current issue of Radiology. Please see my Editor’s note accompanying the STARD publication to learn which other journals will also publish this report.

RSNA to Issue Image License to Authors
In 2001, the RSNA Board of Directors formed an Intellectual Property Task Force and requested that it review the current RSNA policy regarding intellectual property rights. The task force reviewed current policies in place for numerous journals, collected a substantial amount of material and information, and deliberated for numerous hours during a series of conference calls before formulating its recommendation for consideration by the RSNA Board of Directors. Brian C. Lentle, MD, 2002 Chairman of the RSNA Board of Directors, gives additional details in his Special Communication (13), published in the current issue of Radiology. With regard to authors who publish their work in Radiology as of January 1, 2003, they will continue to follow our routine of transferring ownership of copyright to the RSNA. However, RSNA will in turn grant the corresponding author of the published work a license to republish images and artwork without the need to secure written permission from the RSNA. We emphasize that the license for republication applies only to images and artwork, not to any other component of the article (eg, tables, graphs, charts, text) and not to the entire article itself. RSNA does require notification of an author’s intent to allow publication of his or her images and artwork at another commercial enterprise (eg, another journal publisher, a book publisher, or other commercial publisher).

Members of the Intellectual Property Task Force are delighted that the RSNA Board of Directors has adopted this forward-thinking change in policy. As noted by Dr Lentle in his Special Communication, this policy "will provide authors with the flexibility and freedom in using their own images" (13). We urge authors to read Dr Lentle’s Special Communication so as to familiarize themselves with this change. Information will also be included in our Publication Information for Authors guidelines.

Web-based Manuscript Submission and Peer Review
In February 2002, a change occurred in our manuscript submission and review process. We implemented use of a Web-based manuscript submission and peer review system for Radiology—Radiology Manuscript Central. Our decision to do so was based on our belief that the electronic medium will continue as an integral component of the function of a scientific journal office. While we strongly encourage all authors to submit their manuscripts by using Radiology Manuscript Central (see our Publication Information for Authors guidelines), to date we have accepted hard-copy submissions but will not be able to do so indefinitely. Authors having difficulty using Radiology Manuscript Central should seek help as directed in our Publication Information for Authors guidelines. Note that technical support is available from within Radiology Manuscript Central. Also, our Richmond office staff will also be happy to help authors. Contact information is found in the Publication Information for Authors guidelines published monthly in Radiology.

Radiology Manuscript Central provides authors and reviewers a number of advantages, compared with our prior hard-copy submission and mailing practices. Some of these include the following: (a) Submitted manuscripts arrive in our office without delay. This is particularly advantageous for our authors outside the United States whose manuscripts would typically arrive several days or weeks after being sent to us, depending on the manner in which they were mailed. (b) Authors will realize cost savings by not having to prepare three copies of each photographic print. (c) Concerns about image quality are now being addressed before manuscripts are sent to the Oak Brook office for copy editing and production, eliminating the need for changes later in the publication process, when timing is more critical. (d) Authors can check the decision status of their manuscripts at any time of the day (see our Publication Information for Authors guidelines for an explanation of the decision status terms). (e) Reviewers are now notified electronically of our desire to have them review a given manuscript. They are also sent the abstract of the manuscript to further allow them to determine their suitability as reviewers for the given manuscript topic. We strongly encourage reviewers to respond quickly to our query, as we do not wish to delay implementation of the review period. (f) Reviewers now have a full 3-week period during which to review a manuscript, whereas in the past the 1st week of the 3 was not available owing to the routine mailing delivery process from our office and at the receiver’s site. In view of this 1st week of lost time for the reviewers, who therefore typically had available only 2 of the 3 weeks allocated for the review, we contemplated decreasing our review time to 2 weeks, since manuscripts now become available to the reviewer immediately. However, we retained the 3-week period to allow reviewers to familiarize themselves with the online review system and, more important, to actually give our busy reviewers more time during which to complete the review. Currently, we continue to offer a full 3-week review period. (g) On entry of the manuscript decision into Radiology Manuscript Central by our Richmond office staff, authors are notified immediately of the decision. Authors receive the Editor’s decision letter along with other items needed to accomplish the revision. Reviewers are also notified immediately of the Editor’s decision and are sent the reviewer comments.

While most authors and reviewers have responded positively to Radiology Manuscript Central, some have encountered difficulties with use of the system. We have appreciated the information received from these individuals, which allows us the opportunity to provide help and make improvements in our processes. Changes necessitated in the Richmond office coincident with implementation of Radiology Manuscript Central have influenced our processes and caused slight delays in some of the components of work flow in our office. We appreciate the cooperative spirit of those authors who may have received a manuscript decision or follow-up information from us slightly later than in the past, as we continue to improve our work-flow processes. Again, we strongly encourage authors to submit their manuscripts by using Radiology Manuscript Central.

Radiology Online
The electronic version of our Journal, Radiology Online, offers readers a number of features made possible by the electronic medium. These were enumerated in November 2001 (14), when we announced implementation of Continuous Publishing—continuous publication of materials online in advance of their appearance in print. Those articles published online in advance of print represent the final versions of the articles that will also appear in print, not preliminary versions. Although we estimated a potential for some articles to be published 4–5 weeks in advance of print, we have exceeded that expectation. Some now appear online as many as 7 weeks in advance of print. For an author, the online publication date of an article is the publication date, as the National Library of Medicine recognizes Radiology Online as the journal of record. Continuous Publishing is conspicuously displayed in the redesigned Radiology home page (radiology.rsnajnls.org). We urge our readers to access Radiology Online, click on Continuous Publishing, and review the list of articles found therein. By viewing these articles in advance of print, you will have access to new information several weeks before you receive the printed copy of Radiology.

I am pleased to mention two other features—one already available and another projected for availability early in 2003. The first is free online availability of Radiology and RadioGraphics, as of July 2002, to members in training of the RSNA. These trainees represent the future of our specialty, and the RSNA Board of Directors has approved this benefit to encourage reading of the literature early in one’s training. The second feature is for those who have a personal digital assistant, or PDA. From Radiology Online, you will be able to download the table of contents and abstracts of a given issue of Radiology or RadioGraphics, allowing yet another level of flexibility and convenience in your review of the literature.

Statistical Concepts Series
In November of 2002, we began the first of several publications in a section created specifically for them and entitled Statistical Concepts Series (15). Our plan is to publish, both online and in print, one article per month, each of which addresses basic, and yet important, concepts that we believe will be of help to authors and reviewers as they plan their investigations and review manuscripts, respectively. For readers, a knowledge of such concepts can aid in evaluation and understanding of the literature they read. We again thank Kimberly E. Applegate, MD, MS, and Philip E. Crewson, PhD, for coordinating the series (15). Since these articles will be featured in the Statistical Concepts Series section, at a given time all published articles will be available from Radiology Online by clicking first on Browse by Subspecialty Category (Radiology Collections) and then on the title Statistical Concepts Series. Please see this month’s publication by Halpern and Gazelle (16).

Professionalism
During the past several years, the specialty of medicine has come under progressively increasing pressures as changes have occurred in health care delivery systems. The patient-physician relationship has become strained as both patients and physicians have become frustrated in dealing with the pressures arising from patient needs and the available resources to meet those needs. In 1999, in view of the threat imposed on medical professionalism, the importance of the welfare of the patient, and the need for health care reform, three organizations began the Medical Professionalism Project (17). These three organizations (the American Board of Internal Medicine Foundation, the American College of Physicians–American Society of Internal Medicine Foundation, and the European Federation of Internal Medicine) released their report several months ago (17). In their report, they identified three fundamental principles: primacy of patient welfare, patient autonomy, and social justice. They also provided a set of professional responsibilities in the form of 10 commitments to the following: professional competence, honesty with patients, patient confidentiality, maintaining appropriate relations with patients, improving quality of care, improving access to care, just distribution of finite resources, scientific knowledge, maintaining trust by managing conflicts of interest, and professional responsibilities (17).

The report focuses on issues of importance to all physicians who deal with patient care and, thus, patient welfare. In his commentary, Dr Harold C. Sox (17) emphasizes the premise of the report: "Changes in the health care delivery systems in countries throughout the industrialized world threaten the values of professionalism." He comments further that "conditions of medical practice are tempting physicians to abandon their commitment to the primacy of patient welfare." The three organizations responsible for this report consider it a charter that "supports physicians’ efforts to ensure that the health care systems and the physicians working within them remain committed both to patient welfare and to the basic tenets of social justice" (17). I urge our readers who are not familiar with this report to review it.

Last, many of you no doubt have noticed that the October 2002 issue of both Radiology and the American Journal of Roentgenology (AJR) announced a search for a new editor of the AJR. After many years, the current Editor, Lee F. Rogers, MD, has decided to complete his years of service. During his years as editor of the AJR, Dr Rogers continued the trend of former editors—the publication of an outstanding quality journal that serves the needs of its readers and disseminates information on the important use of imaging for patient care. We applaud Dr Rogers for his dedication and service as editor and for the positive imprint he has made on the AJR by virtue of both the changes he has implemented and his unique style. Lee, we wish you the very best in your transition from editor to life after editor!

In closing, I look forward to the next several years with great enthusiasm, realizing my good fortune to be associated with outstanding authors, outstanding reviewers, and a dedicated readership!

FOOTNOTES

See also the articles by Reitsma et al and Hwang et al in this issue.

REFERENCES

1. Proto AV. Radiology—1998 and the future. Radiology 1998; 206:1-2.[Free Full Text]
2. Proto AV. Radiology 2001—the upcoming year. Radiology 2001; 218:1-2.[Free Full Text]
3. Proto AV. Reply (letter). Radiology 2000; 215:616.
4. Proto AV. Reply (letter). Radiology 2000; 217:598.[Free Full Text]
5. Proto AV. Reply (letter). Radiology 2000; 217:599.[Free Full Text]
6. Probyn LJ, Asch MR. The effect of changes in guidelines for authorship on current Radiology publications (letter). Radiology 2000; 215:615-616.[Free Full Text]
7. Morillo AJ. The authorship dilemma: will it ever be solved? (letter). Radiology 2000; 217:597-598.[Free Full Text]
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10. Drazen JM. Reply (letter). N Engl J Med 2002; 347:1118.
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12. Bossuyt PM, Reitsma JB, Bruns DE, et al. Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. Radiology 2003; 226:24-28.[Abstract/Free Full Text]
13. Lentle BC. Authors of journal articles and educational materials will have an image license from RSNA. Radiology 2003; 226:8-9.[Free Full Text]
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15. Proto AV. Radiology 2002—statistical concepts series. Radiology 2002; 225:317.[Free Full Text]
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