^{Published October 22, 2020}

A year ago, when I was asked to prepare a talk on the history of radiology journals, little did I think that, because of a pandemic, a new chapter would be added to the history of medical journals in general, that of how public anxiety would be assuaged by the dissemination of medical knowledge via journals and mass media, in print and online. Academic radiology journals have set high standards of peer review and avoidance of conflicts of interest for over 100 years, but these are time-consuming processes at a moment when there is instant demand for new medical knowledge in so many fields.

Just this June, while I was writing, the rush to publish resulted in the retraction of studies from respected publications such as New England Journal of Medicine and Lancet because the authors could not verify a new database on which the results depended and, in other instances, the results of published articles were considered statistically invalid. 

To radiology’s credit, the history of its academic journals has always been tied to how they assure scientific honesty, how fraud might potentially creep in, and how peer review attempts to prevent its appearance. Whether in print or online, these journals try to bring us legitimate validation of the newest developments in our field, simultaneously providing an archive of the history, organization, and expanding scope of our profession.

Medical journals are no stranger to pandemic. During a smallpox outbreak in Paris in 1820, there was uncertainty about the effectiveness of the new vaccine. Journalists were invited to debates at the Academie Royale de Medecine and quickly relayed their versions of them, setting a panicked public atwitter. The Academie sought to control the message of its debates, publishing its own accounts, which led to the establishment of the academic journals we have today. It took until the mid-1900s for the concept of peer review, with its panels of outside experts and deliberate processes of revision and resubmission, to be widely adopted.

Even in their earliest incarnations, the speed of disseminating information via journals was considerably slower than that of less reliable mass media—and those speeds, and often gaps, have increased over generations of medical practice. A recent New York Times article observed that during a pandemic, journals are pressured to be not only relevant, but also responsive to the urgency of the circumstances and maintain their standards, which require caution. In January 2020, 50 papers on the novel coronavirus, COVID-19, had been published. By the start of June 2020, 17,000 published papers about COVID-19 were listed in the National Library of Medicine’s database, referred to by some as an “infodemic.” Respected journals have quickly disseminated COVID-19-related articles free of charge online, and new websites with names like bioRxiv  (pronounced “bioarchive”) and medRxiv have included many of-the-moment studies that did not complete peer review; last I checked, these two sites were listing over 4,000 papers on COVID-19.

No matter how trying the times, radiology has kept peer review at the heart of its academic journals. The system is not perfect, often taking a year from submission of an article to publication. Our major journals now shorten those times using electronic submission and review, but formal peer review will, and should, always remain a deliberative, time-intensive process. A recent article in Journal of the American Medical Association highlights the trade-off between learning and doing during a pandemic—that is do something (treat the patient) or learn something (appropriately test a new technique or therapy), a dilemma often referred to as the “exploitation-exploration trade-off.” Radiology journals have successfully navigated our advancing profession through the landmarks, and hazards, of this evolving debate between quick change and cautious optimism, or skepticism, for more than a century.

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Archives of Clinical Skiagraphy was the first radiology scientific journal and appeared in May 1896. Its founder and editor was Sydney D. Rowland (1872-1917), a medical student at St. Bartholomew’s Hospital in London. The first issue comprised 16 pages with an article by Rowland on the method of taking a radiograph, or skiagram as he called it, and six photographic plates. Seven months later the journal became Archives of Skiagraphy. Skiagraphy was a term proposed by Rowland that literally means “shadow writing,” derived from the Greek terms skia (σκια) and grapho (γραφω). His first editorial stated, “The object of this publication is to put on record…the most striking applications of the new photography to the needs of medicine and surgery.” In 1897, the journal was renamed, again: British Journal of Radiology.

The earliest radiology journals that appeared in the United States were the precursors of the present American Journal of Roentgenology (AJR) and Radiology. Dr. Heber Robarts (1852-1922), a surgeon for the Great Northern Railway, established a laboratory in St. Louis for the further study of the x-ray phenomenon. His ambition was to establish an American periodical devoted to the interests of this new medical specialty. His American X-ray Journal was initially a monthly magazine, first published in May 1897, devoted to practical x-ray work and allied arts and sciences. Robarts noted that the application of the “new rays” allowed for “the ease and certainty of aiding diagnosis which has advanced more in the past 12 months than any previous hundred years.” He went on to say “that no advertisements shall appear in this journal that savor of quackery, deception, or fraud,” an early manifestation of the intended integrity of a medical journal. In 1900, Robarts organized “the Roentgen Society of the United States” and was chosen as the first president of the society. The ranks soon became infiltrated by commercial interests, and Robarts disposed of the journal’s control.

In 1906, the American X-ray Journal’s editorship passed to Dr. Preston Manasseh Hickey (1865-1930) of Detroit, a pathologist, otolaryngologist, and skilled amateur photographer who, with a colleague, purchased one of the first x-ray machines in Michigan. In 1922, Hickey was appointed chair of radiology at the University of Michigan; he is counted among the founding members of the American Roentgen Ray Society (ARRS). ARRS started publishing the scientific presentations at its meetings as Transactions, and after 1906, in the American Journal of Roentgenology and Radium Therapy, AJR’s predecessor. Hickey was editor from 1906 until 1916, and he was responsible for the terms “roentgenology,” “roentgenogram,” and “radiograph.” He was also instrumental in standardizing radiographic nomenclature and report structure.

At this point, a new radiology society gave rise to a second credible journal. ARRS was considered an “Eastern” society with most of its meetings held in that part of the country.  Attendance for Hickey’s colleagues west of the Alleghenies was difficult, and many “Western” radiologists were ineligible for membership according to ARRS’ professionally elitist criteria. Some sensed that there should be a place in organized radiology where young physicians were encouraged to develop, so Dr. Edwin C. Ernst (1885-1969) of St. Louis convened a meeting in St. Louis in 1915. His organization was originally known as the Western Roentgen Society, and in 1922, its name was changed to the Radiological Society of North America (RSNA). RSNA’s 1923 articles of incorporation included a plan “to maintain a journal in order that legally the society should own and control, RADIOLOGY,” which was then beginning publication. Dr. Maximilian John Hubeny (1880-1942) was editor from the journal’s inception until his departure in 1931.  Under Hubeny’s editorship, Radiology was immediately established as a quality medical journal, and he supervised its first 16 volumes. AJR and Radiology remain the flagship publications of our profession.

In more recent decades, as sub-specialization and significant technologies like CT reshaped the profession, different types of radiology journals appeared, the predecessors of today’s several respected publications targeted to particular imaging techniques and specific anatomic areas or diseases of an organ system. In 1977, once CT had advanced past its initial novelty and rarity to become widely accepted, Journal of Computer Assisted Tomography was first published by Raven Press as a technique-oriented journal dedicated to emission and transmission tomography, under the editorship of Dr. Giovanni Di Chiro (1926-1977) of the National Institutes of Health. Soon after in 1980, Dr. Melvin Figley (1920-2010) at the University of Washington, editor of AJR, helped establish the sub-specialized American Journal of Neuroradiology (AJNR) as a joint project of ARRS and American Society of Neuroradiology (ASNR). Dr. Juan Taveras (1919-2002), a founder of ASNR in 1962 before moving to Massachusetts General Hospital, was AJNR’s first editor. Selected articles were reprinted in AJR a month after they appeared in AJNR, elevating neuroradiology’s academic credibility among the various neurosciences and setting a precedent for successful organ system-oriented radiology journals in other sub-specialties.

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The long history of responsible medical journalism is the pride of radiology. Ethical conduct by editors and reviewers is mandatory in academic journals, and authors are always responsible for honest conduct of research. Conclusions are evaluated based on credible data.

There is, admittedly, a recent proliferation of for-profit journals, many of which are internet-based, which charge authors a fee for publication, have questionable peer review, and draw advertising away from established academic journals. It is increasingly our responsibility as radiologists, particularly in the rapidly changing times COVID-19 makes so immediately familiar, to respect and protect the legitimate journals our specialty has so long esteemed—the traditional publications highlighted in this article and the many recent efforts space limits my mentioning—as the primary sources of information for our practices in an era when expansive, even sensational, mass-media coverage of new techniques, cures, and devices rushes all of us ahead.

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This article was first published in the Summer 2020 edition of ARRS’ SRS Notes. The opinions expressed in InPractice magazine are those of the author(s); they do not necessarily reflect the viewpoint or position of the editors, reviewers, or publisher.