Better radiology in the BMJ

Abstract

Despite improvements already made, we still have more to do

The BMJ has a history of being self critical. In 1976 we published a review of 62 BMJ research papers, which showed that 32 of them had statistical faults and five had made claims in their abstracts that were not supported by their results.¹ These mistakes occurred because at that time statisticians were not commonly involved in research papers, either as authors or peer reviewers.² To improve the reliability of published research, the BMJ was one of the first medical journals to introduce statistical review of all published research papers, and the role of statisticians in peer review continues to be of interest today.³ We now plan to do the same for radiology, using external advisors and radiologists to guide us and improve our content.

Twenty years ago radiology was mainly plain radiographs viewed on light boxes. Now digital technology means that multislice computed tomography, magnetic resonance imaging, Doppler ultrasound, and even positron emission tomography can be viewed on computers in hospitals and across the world via the internet. We are concerned that the radiology content and images in the BMJ may not have kept up with these changes. In June 2007, an external review of the BMJ from one of our radiology advisors showed that we had used radiological images in only six articles in the previous six months—four of them in the Practice section and two in the Minerva section. Of these six images, most were not adequately explained, and none had arrows to indicate the relevant abnormalities or findings.

So what have we done to remedy this? Firstly, we have set up a panel of radiologists who will review all images for clinical articles before they are published in the BMJ (http://resources.bmj.com/bmj/about-bmj/radiology-reviewers). (We do not currently peer review images in the News section as these are journalistic rather than educational.) We aim to use high quality images, with accurate figure legends and arrows to identify the abnormalities. Secondly, we have increased the amount of educational content on radiology. The BMJ series Rational Imaging^{4 5 6} provides updates for doctors on the best use of different imaging methods for common or important clinical presentations. We welcome submissions for this series (see instructions for authors on bmj.com). Also, from March we will feature a Picture Quiz using radiological and clinical images (http://resources.bmj.com/bmj/authors/types-of-article). Thirdly, we are creating a bank of radiology images to use with different articles and would like to encourage readers to send us interesting images, provided they have adequate consent from the patient for publication (box). Finally, we intend to keep readers abreast of “hot topics” and developments in radiology. For example, after discussions with radiologists at the Royal College of Radiology’s annual meeting in September 2007, we commissioned a feature about the ethics of private companies offering whole body computed tomography screening.⁷ Other articles are planned.

Guide for BMJ image bank

• Images must be high resolution at 300 dpi

• For the Picture Quiz, images need to be at least 8 cm wide; for all other articles they should be at least 12 cm wide

• All images should be sent to us as jpeg files

• We need two versions of each image, one that shows just the image and one that includes arrows to indicate the abnormality

• All images need to have a figure legend

• In the initial stages we would prefer images that show “classic” signs of common illnesses

• All images must have a signed BMJ patient consent form that specifically allows publication in the BMJ

• Consent forms can be found at: http://resources.bmj.com/bmj/authors/checklists-forms/patient-consent-form

Like statistics, radiology is an increasingly complex field in which it is possible to get things embarrassingly and dangerously wrong. We hope our panel of radiologists will save our blushes and help you to raise your radiological game. We welcome your feedback and suggestions for Picture Quiz and Rational Imaging articles, which can be emailed to Amy Davis (adavis@bmj.com).