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Radiology 2000: Reviewing for Radiology

Index terms: Editorial • Radiology (journal)

The quality of a scientific journal is, in a major way, a reflection of the quality and dedication of its reviewers (1). Having a knowledge of the literature and expertise in the subject matter, the reviewer provides valuable information for the Editor regarding the importance of a manuscript, its science, and the advances in knowledge contained therein. The dedicated reviewer looks seriously upon the task at hand and returns the review within a reasonable time frame. Such timely return allows the Editor to maintain a reasonable time to first decision for the manuscript and a reasonable time to publication, although the latter depends in a substantial way on the time taken by the author to accomplish needed revisions. The Editor must maintain a balance between timeliness and quality, both of which authors value. Once that balance is achieved for a given journal, it stands to reason that authors will submit their best work to that journal, taking pride in both the quality of their publication and the journal in which it appears.

Shortly after I was appointed Editor, a number of reviewers contacted me to inquire whether I would provide guidelines for reviewing. My response was that I would; but first I needed to accumulate experience to determine, in fact, what was the most helpful review for me when rendering a decision on a manuscript. In the meantime, the system in place and used by my predecessor had been working well so that it seemed prudent to continue the same. Now in my 3rd year as Editor, I am prepared to offer those guidelines for our reviewers. However, I offer the guidelines while stressing the following. First, we at Radiology are fortunate to have a large cadre of outstanding reviewers. They have provided us their insights and dedicated service for many years, and we look forward to their continued service in the years to come. Second, I realize that reviewers have their own preferred styles of reviewing and acknowledge that those varied styles have been of immense help to me over the past few years.

Whereas the information provided below is intended for our reviewers, we hope our authors will find it of use to them in the preparation of their manuscripts.

Essential Components
From my perspective, the essential components of a review are as follows:

Identifying Information
Indicate the manuscript number and manuscript title.

Summary
Provide a one-paragraph summary of what was done and what was found. This summary provides the Editor with a background that is helpful in determining the importance of the specific suggestions for revision appearing later in the review.

Major Strengths
List the three major strengths of the manuscript—give more or fewer than three as appropriate. Examples include, although are not limited to, the following: importance of the findings, sound methodology, control for bias, appropriate subject population, topic of current interest, appropriate statistical analysis, immediate practical value for daily image interpretation, innovative technique, prospective study, message of immediate importance for patient care.

Major Weaknesses
List the three major weaknesses of the manuscript—give more or fewer than three as appropriate. Examples include, although are not limited to, the following: minimal or no importance of the findings, flawed methodology, biased subject population, insufficient number of subjects, missing exclusion and inclusion subject criteria, topic already well studied by others as evidenced in the published literature and no substantial incremental knowledge is provided, subject matter not appropriate for the Journal, data do not support the conclusions, study limitations are not discussed by the authors, interobserver and intraobserver agreement not evaluated although appropriate for the study, inadequate or inappropriate statistical analysis, excessive speculation, evaluations performed with outdated techniques.

Advances in Knowledge
List the advances in knowledge provided by the study. These should be readily apparent from reading the manuscript. Do you agree that the advances as stated by the authors are true advances? Or have they been previously reported? If so, is another study documenting a prior report warranted? Are the advances important? Or do they have no apparent application or very minimal application?

Specific Comments
A review of each section of the manuscript should then follow. Indicating the manuscript page number to which a comment applies is helpful. The reviewer should offer specific suggestions for improvement, mention any concerns or disagreements with statements made and why, and indicate any items that are essential but missing from the sections of the manuscript.

Abstract.—The Abstract should be read after you have evaluated the full manuscript to determine if it includes the essential information in each of its sections. Is the purpose of the study clearly articulated? Does the Materials and Methods section indicate the number of subjects, the various groups including controls, the procedures performed, and the specifics of evaluation? Are specific data given in the Results section, along with results of any statistical evaluations performed? Is the conclusion warranted based on the data? Lastly, and importantly, are there any inconsistencies within the Abstract itself or between the Abstract and the text, particularly with regard to numerical data?

Introduction.—This section of the manuscript should typically not exceed one and a half typewritten pages and should not include an extensive review of the literature. Does the author present a logical case for why the study was undertaken? Are appropriate references included? Does the author clearly state the hypothesis being investigated or purpose of the study at the end of the Introduction (last one to two sentences)? Is there misplaced information that belongs in another section of the manuscript (authors sometimes state what was done or include results)?

Materials and Methods.—Rarely should this section of the manuscript exceed four to five typewritten pages. For studies involving human subjects, were institutional review board approval and patient informed consent obtained and so indicated in the first paragraph? If not, is it clear that they were not needed? For studies involving animal subjects, is there indication in the first paragraph that approval of the institutional animal care committee was obtained?

Is it clear whether the study is prospective or retrospective? Has the patient population been fully defined (age range, sex, inclusion and exclusion criteria, consecutive or random selection)? Have the control subjects been clearly defined? Is there a logical presentation of the total number of subjects and the division into various groups with the rationale for the same? Is there a clear description of the procedures performed so that the study can be repeated by others (imaging equipment used, technical imaging parameters, images obtained, other procedures)?

Do the authors indicate specifically what was evaluated and how the evaluations were performed (blinded or unblinded to other information, time sequencing to avoid recall bias, random ordering, one author only versus one of several authors, more than one author with multiple readings done together or independently, resolution of discrepancies)? Are the statistical methods clearly defined? If appropriate for the manuscript, is there a succinct but adequate description of any theoretical considerations or proposed models?

Have the authors included in Materials and Methods all items evaluated and for which they present results in the Results section? Would subheadings help organize the Materials and Methods section and provide additional clarity? Is there misplaced information that belongs in another section of the manuscript (authors sometimes include results in Materials and Methods or information more appropriate for the Discussion section)?

Results.—Rarely should this section of the manuscript exceed four typewritten pages. Have the authors presented results for all the items they evaluated in Materials and Methods? Are the results presented in logical sequence based on the information and subheadings given in Materials and Methods? Would subheadings provide additional clarity? Do the authors give results for their statistical evaluations and the significance of the same? Are numerators and denominators provided for percentages, sensitivity, specificity, accuracy, positive predictive value, and negative predictive value either in the text or in the tables? If tables and figures are included, do the authors present the most important features in the text and the specifics in the tables (text and tables or figures should not be a mere repetition of each other)? If tables are not included, should they be to help organize the data and decrease the length of the text? Is there misplaced information that belongs in another section of the manuscript (authors sometimes introduce Materials and Methods information or present conclusions).

Discussion.—Rarely should this section of the manuscript exceed four to five typewritten pages. Have the authors clearly stated the advances in knowledge provided by their study and the appropriate conclusions? Are the conclusions supported by the data? Have the authors avoided a mere repetition of results? Have they avoided presentation of an extensive review of the topic and have they presented instead how their results and conclusions relate to other relevant studies? In short, is the Discussion focused and does it give the important findings in the context of existing knowledge?

Is there a discussion of the limitations of the study and future work to be done? Have the authors clearly linked their conclusions with the hypothesis investigated or the purpose of the study? If the authors present new hypotheses or speculations, are they warranted and clearly identified as such? Are any given recommendations appropriate, based on the study?

For animal or other nonhuman experimental studies, has a final paragraph on potential future practical applications been included? Is there misplaced information that belongs in another section of the text (authors sometimes give additional results) or that should be eliminated (recent experience with other subject observations or ongoing investigations that are not part of their study being reported)?

Appendix.—Have detailed background information, extensive mathematical derivations, and extensive statistical analyses been placed in an Appendix, with reference to the same in the appropriate sections of the text? If not, should items included elsewhere in the text be placed in one or more appendices?

References.—Are they listed in the order in which they are cited in the text? Do they adhere to our guidelines regarding required information? Are they excessive or outdated? Have important references been omitted, especially those that are relevant to the authors' work (many of our reviewers perform database searches in preparation for reviewing a manuscript)? Have the authors misquoted or incorrectly cited references in support of a statement they have made (such information might alternatively be mentioned by the reviewer when critiquing another section of the manuscript where the reference is cited)?

Tables.—Are the tables needed to display the data? Do they merely repeat the text, in which case they can be eliminated or the text can be modified to mention only the most important features? Are all abbreviations explained? Are numerators and denominators given if not given in the text (see Results)?

Figures.—Do the captions clearly state the important points being shown? Are all labels found on the illustrations also mentioned in the caption? Conversely, are the features mentioned in the caption also labeled on the illustrations? Are the type of image, whether or not contrast material was used, and the plane of the image given? Is pulse sequence information included for MR images? Are the stain and original magnification given for photomicrographs? Are there too many or redundant illustrations? If so, which can be eliminated?

What to Do and Not to Do
There are a number of general guidelines for evaluating a manuscript. They are important not only for the author but also for our Editorial Office:

1. Do not ask a colleague, who may have expertise in the subject matter, to review the manuscript for you unless you first notify the Editorial Office of your intent and receive our permission to do so. We may wish you to return the manuscript instead for reassignment to another reviewer.
   
2. Do not share the contents of the manuscript with anyone. It is permissible to ask a colleague with special expertise in a subject matter area of the manuscript to assist you with the review provided he or she understands that the contents of the manuscript are strictly confidential and are not to be shared with others.
   
3. Do not copy the entire manuscript or any of its sections (see no. 4).
   
4. Do not make marks in the original manuscript, as they are distracting should the manuscript be sent to another reviewer for comments. If you copy the manuscript for the sole purpose of expediting your review procedure (marking areas that need improvement), please destroy this copy once your review has been sent to us.
   
5. Do return the entire manuscript to the Editorial Office with the review.
   
6. Do not contact the authors for clarification of any items in the manuscript should the authors have unblinded their identities.
   
7. Do not speculate in the comments for authors as to who are the authors of the manuscript. If you consider that your knowledge of the authors of the manuscript, whether by speculation or unblinding by the authors themselves, may cause you to be biased for acceptance or rejection, do not review the manuscript. Notify the Editorial Office immediately so we can reassign the manuscript.
   
8. Do notify the Editorial Office if you are aware of a publication that is substantially similar to the manuscript you are reviewing (eg, number of patients, methodology, textual information). This will allow us to look into the possibility of redundant publication (see the Publication Information for Authors appearing in the most recent issue of Radiology).
   
9. Do not send the review on letterhead or other paper containing identifying information (use plain paper). Just as the reviewer is blinded to the author's identity, so is the author blinded to the reviewer's identity. There are differences of opinion regarding blinding of the authors' and reviewers' identities (2–4). However, we currently subscribe to blinding of both in our review process.
   
10. Do not use derogatory statements. They alienate authors and serve no constructive purpose. In fact, they can be destructive, especially for those young in their academic careers. Instead, offer a series of comments that point out the deficiencies and indicate how improvements may possibly be made.
    
11. Do number your individual comments consecutively for the entire review beginning with the "Major Strengths" section, rather than numbering the comments consecutively within each section.
    
12. Do not include multiple comments in a single paragraph. List each comment separately with consecutive numbering of all.
    
13. Do not send a one-sentence review such as "This manuscript contains flaws that are too numerous to list." This is of no help to the authors or the Editor. Instead, be specific and list several of the more important flaws. Similarly, it is uncommon that a study is in need of no revisions.
    
14. Do not focus your review on grammatical and spelling errors (our manuscript editors will perform this task) UNLESS they might cause misinterpretation of the meaning apparently intended by the authors.
    
15. Do advise the Editor if companion manuscripts (Parts I and II) can be combined into one. Alternatively, does each part stand on its own and does the content of each merit a separate manuscript? It has been my experience that most companion manuscripts contain substantial redundancies, and thus I typically encourage consolidation into one manuscript.
    
16. Do check for inconsistencies in the numerical data (within a section of the manuscript and between sections, between the text and the tables and figures, within a table, and within a figure).
    
17. Do check for contradictory statements throughout the manuscript.
    
18. Do substantiate generic statements you make, such as "The methodology is flawed," "The authors have introduced bias," "The data have been misinterpreted," and other such statements, by giving specific information.
    
19. Do offer references to document your comments that relate to the authors' results disagreeing with the published literature, if not already done so by the authors, or to the results contained in the manuscript having already been published.
    
20. Do not encourage authors to provide information that is extraneous to the study, in spite of your own interest in the same.
    
21. Do indicate if you consider the subject matter of the manuscript inappropriate for our readership and state why.
    
22. Do indicate your overall impression regarding acceptance or rejection on the Reviewer Evaluation Sheet, which is intended for this purpose. Make sure the impression is substantiated by the comments contained in the review.
    
23. Do use the Reviewer Evaluation Sheet and Comments for the Editor to indicate if a rejected manuscript has potential for publication if revised and resubmitted. If included in the comments for the authors instead, such information can be misleading for the authors who might then follow your suggestions, although the Editor may have rejected the manuscript without offering an opportunity for resubmission in view of the comments of all reviewers and the evaluation performed in the Editorial Office.
    
24. If you wish to communicate comments intended for the Editor only, do so on the reverse side of the Reviewer Evaluation Sheet or on a separate sheet of paper.
    
25. Lastly, do read the review you have prepared as if you were the author receiving it. Are the comments derogatory? Is it clear that the reviewer understood the study and made suggestions for improvement of deficiencies? Or has the reviewer made generic statements without providing specific information?
    

Peer review is an essential component of the final product that is our monthly journal. The reviewer's expertise in the subject matter and knowledge of the literature help ensure that the manuscript under evaluation contains up-to-date information and is appropriately focused on the advances in knowledge contained therein. We hope the above guidelines are of help to both our reviewers and potential authors, and we welcome any feedback they would like to provide. Lastly, we thank our reviewers for their outstanding service to the peer-review process and Radiology.

References

1. Pitkin RM. The care and feeding of reviewers. CBE Views 1997; 20:191.
2. Jones AH. Third international congress on peer review in biomedical publication. CBE Views 1998; 21:91.
3. Cho M, Bingham C, Van Rooyen S, Cagle L. Concealment of authors' and reviewers' identities in peer review. CBE Views 1999; 22:197.
4. Ingelfinger F. Peer review in biomedical publication. N Engl J Med 1974; 56:686-692.

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