Clinical Radiology (1992) 46, 1-3

Editorial The Refereeing Procedures for Papers Submitted to Clinical Radiology

To coincide with the introduction of a new reference style for Clinical Radiology, I thought it would be of interest to authors and readers alike to hear how the various Editors decide what should be published and how submitted papers are handled.

Criteria for Acceptance

It is difficult to give simple guidelines on how to write an original paper, but it is possible to convey some of the more frequent reasons why papers are rejected. The paper may have no clear aims or, alternatively, does not present new information. Even if the objectives are clear, the paper may not answer the questions posed or, more usually, the questions cannot be answered from the methods and materials used. A common problem is inadequate proof of diagnosis of the cases under investi- gation. Often, the conclusions are of little or no impor- tance, or are already well known.

Having decided on a project which will answer a significant question or have an important message, authors should pay great attention to the presentation of their material. Clearly, full papers' vary widely in their aims and it is only possible to give advice in the most general terms, but the following guidelines will, hopefully, help prospective authors when submitting their papers to this or other radiological journals.

The Abstract should he a true synopsis of the aims and conclusions of the paper, with the appropriate amount of data to indicate the materials and methods used and the significance of the results. The abstract should be no longer than 200 words.

The Introduction should set the scene by clearly stating the aims of the paper and summarizing any relevant previously published observations.

The section devoted to Materials and Methods should contain all relevant details. For a paper describing the appearances of a particular disease, for example, it is essential to indicate the criteria that had to be met to include the patient in the study and to remember that these criteria must be generally acceptable, e.g. histologi- cally/cytologically confirmed, or meeting the criteria specifically enumerated by a national or international body such as the American Thoracic Society or World Health Organization. The common fault of using radiolo- gical criteria alone as evidence of a disease is to be avoided wherever possible. For articles describing the accuracy of imaging tests in specific disorders, it is essential to state criteria for interpreting the images as well as ensuring that an acceptable gold standard is used. Indeed, it is not possible to give figures for sensitivity, specificity and predictive values, or any of the data, such as ROC curve, which are dependent on these figures, unless an indepen- dent gold standard is used. When there are good reasons why this type of information is unavailable or if the study design does not require an independent gold standard, then it is important to say so explicitly and explain why. I f

control groups are used, they must be carefully matched to the cases being studied and the criteria for using particular subjects as controls must be just as strict as those for abnormal cases. Statistical analyses should use appropriate standard methodology and the statistical techniques used to analyse the data should be stated. In a technical subject, such as diagnostic imaging, it is clearly important to include sufficient details of the imaging techniques actually used in order that others may be in a position to use the same methodology.

The Results should be expressed as simply as possible, while at the same time ensuring that all the relevant details are given. Indeed, the study should be designed to yield results that can be expressed in a simple manner without numerous caveats. The results should also, whenever possible, be presented in a standard manner. A new 'index' or a new 'scale' should only be introduced if strictly necessary and carefully explained. Also, the justification for not using previously accepted methods of expressing the results should be clearly stated. Figures and tables should be designed to give the maximum amount of information in the most easily understood form.

The presentation of complex results is often the most difficult part of any paper and it is the part that will be most carefully perused by any referee. The sort of questions going through the mind of the referee will be:

1 Are the results presented in a valid manner and justified according to the materials and methods?

2 Are the data statistically significant and are they of sufficient interest to warrant publication?

3 Are all the relevant results presented or have some results which could have negated the conclusions of the paper been suppressed?

4 Are all the results comprehensible? 5 Is it possible to compare the data with previous

publications on the subject?

I f the answers to any of these questions are unsatisfac- tory, then the referee may ask for a revision or may recommend rejection of the paper.

The Discussion section should be exactly what it says it is: a discussion of the previous sections, noting and explaining problems with methodology or data presen- tation and amplifying conclusions. It should be clearly and closely related to the primary aims of the paper; authors should be very careful about including lengthy discussions of topics which do not relate to the aims of the study being reported. A common fault, which irritates referees and frequently leads to requests for revision, is to record the results in the discussion section rather than in the results section. The discussion should also review the available literature and indicate how the present paper alters or adds to the current body of knowledge. Authors should review all the published literature pertinent to their topic and then carefully select which papers to refer to in the discussion. A common fault is to draw conclu- sions which cannot be justified from the results being

2 C L I N I C A L R A D I O L O G Y

presented. For instance, claiming that ultrasound is indicated for diagnosing a particular condition based on just a small series of cases in which the technique happened to be beneficial. Other frequent faults are: to claim originality when other publications have made the same point or presented similar data; to devote too much space debating issues which, though they may have been raised in the discussion section of a previous paper, are not widely held views; and stating as established fact conclusions from previous papers that are conjectural rather than based on the data in the paper concerned. References to all major points in the discussion are of great importance. I f the conclusions or ideas being quoted are not referenced, then an enquiring reader, or referee, will be unable to check for him or herself the validity of the statements.

The reference style should conform to the 'Instructions to Authors ' . To present a paper using an alternative style is equivalent to stating that the paper has been rejected by another journal and that is an unwise thing to do when submitting afresh. It is also frustrating for referees and editors to have to spend time and energy changing reference styles. And whilst on this point, it is important to follow all other 'Instructions to Authors ' , particularly items like double-spacing, including page numbers, and taking responsibility for the accuracy of references. Great attention should be paid to general writing style. Simple, grammatically correct, unambiguous sentences with clear-cut logic are the ideal to aim for.

For those who wish to avoid pitfalls and to avoid having their papers returned as being unsuitable for publication, I would recommend the paper by Home [1] which very neatly encapsulates the reasons why many submitted papers do not appear in print despite the considerable effort that has gone into producing them. The recent articles by editors of two major North American radiological journals [2,3] also offer valuable and authoritative advice to authors.

It is easier to convey the criteria for accepting a case report than a full paper: a The greatest priority is given to reports with an explicit

message. There is no magic number of previously reported cases which would negate the acceptability of a case report. What matters more is whether the case or phenomenon being reported would be of interest to readers of the journal. Some entities and phenomena are well known to other disciplines in medicine, and may have been published in non-radiological journals, but may, on occasion, be worth bringing to the notice of radiologists.

There is one important feature to remember when submitting a 'unique' case. Some things are intuitively obvious, e.g. a CT scan appearance of some unremark- able vascular variation that would not cause confusion with pathology or the appearance of a metastasis in an unusual site. Others are generally taught or to be found in textbooks but are not specifically described in a major journal. When cases fall into one of these categories, a referee may recommend rejection, even if a similar case has not been published in a journal before.

b Acceptable proof of diagnosis, as discussed above, is just as vital for a case report as it is for a full paper.

c Good reproducible illustrations are of importance. A particular case or problem might be worth publishing if the illustrations are of good quality and are informa-

d

e

tive, whereas an otherwise identical but poorly illus- trated example might not warrant publication. A well written concise discussion emphasising the message of the report is a great advantage. A well chosen, up-to-date list of references which provides an appropriate guide to the literature on the topic in question is of great help. There will, in practice, rarely be a very great number of references because the literature for a case report, by virtue of its rarity, will rarely be extensive.

The Review Process

Our initial review process is designed to provide a considered decision with a minimum of delay. Papers received by Clinical Radiology are reviewed by two referees (one of whom is almost invariably an Assistant Editor) and by either the Editor or one of the two Deputy Editors. Our goal is that the initial review process should take, on average, no longer than 5 weeks.

When a paper is received in the Editorial Office, the Editor (or a Deputy Editor if the Editor is unavailable) decides which member of the Editorial Board will act as Assistant Editor for the paper. In order to save time, this decision is usually taken over the telephone and is based on the title and on details contained in the abstract. Both copies of the paper are immediately sent to the Assistant Editor who then sends one copy to an expert referee of his or her choice. This referee is given two weeks to provide a detailed critique of the paper and guidance on whether the paper is suitable for publication. The Assistant Editor will then make a recommendation to the Editor or designated Deputy Editor, who will read the paper and make the final decision, taking the advice of the Assistant Editor and referee into account. Papers may be accepted or rejected outright. The others will be placed into one of two categories:

b

Accept subject to modification This category is chosen when, in the Editor 's /Deputy Editor 's opinion, the authors will be able to respond adequately to recommendations for change without too much difficulty. Reject but invite resubmission in a modified form This category is reserved for papers that contain worthwhile material but which need significant altera- tions. The resubmitted versions of such papers are invited on the understanding that there is no guarantee they will be accepted. Once resubmitted, they are subjected to the same refereeing process as an original paper. It is important for authors to respond fully to the suggestions for revision. Experience has shown that authors often try to avoid making the radical changes that are sometimes needed, which may then lead to frustraton on the part of the referees and dissatisfac- tion on the part of the authors when the Editors do not accept the manuscript.

This careful review process, whilst time-consuming, is a vital and necessary process, and is particularly useful for papers which are, in fact, published, because the recom- mended revisions almost invariably improve the quality of the paper. It is common for authors to be given advice on restructuring a paper, revising methods, reanalysing data, etc., in order to make their points more forcefully.

REFEREEING PROCEDURES 3

R E F E R E N C E S ~

1 Home PD. Techniques for ensuring that your next paper is quite unsuitable for publication. Journal of the Royal College ~?f Physicians of London 1988;22:48 50.

2 Berk RN. Preparation of manuscripts for radiology journals: advice to first-time authors. American Journal of Roentgenology 1992; 158:203-208.

3 Siegelman SS. Advice to authors. Radiology 1988;166:278-280.

P. A R M S T R O N G Editor, Clin ica l R a d i o l o g y

Royal College o f Radiologists 38 Portland Place

London W I N 3DG