J Meyer

J. A. Reekers

JP Ioannides

S. Bipat

English

PubMed

Reekers, J. A.

Bipat, S.

NARCIS 

Quality of Interventional Radiology Journals and Papers

Crossref

Reekers, J.A.

International Migration, Integration and Social Cohesion online publications

UvA-DARE is a service provided by the library of the University of Amsterdam (https://dare.uva.nl)UvA-DARE (Digital Academic Repository)Quality of Interventional Radiology Journals and PapersReekers, J.A.; Bipat, S.DOI10.1007/s00270-009-9768-3Publication date2010Document VersionFinal published versionPublished inCardiovascular and interventional radiologyLink to publicationCitation for published version (APA):Reekers, J. A., & Bipat, S. (2010). Quality of Interventional Radiology Journals and Papers.Cardiovascular and interventional radiology, 33(1), 1-2. https://doi.org/10.1007/s00270-009-9768-3General rightsIt is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s)and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an opencontent license (like Creative Commons).Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, pleaselet the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the materialinaccessible and/or remove it from the website. Please Ask the Library: https://uba.uva.nl/en/contact, or a letterto: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. Youwill be contacted as soon as possible.Download date:15 Apr 2023EDITORIAL / OPINIONQuality of Interventional Radiology Journals and PapersJ. A. Reekers • S. BipatPublished online: 5 December 2009 The Author(s) 2009. This article is published with open access at Springerlink.comWe read with great interest the paper recently published inJournal of Vascular and Interventional Radiology (JVIR),by Meyer et al., entitled ‘‘Quality of Interventional Radi-ology Literature: A Review of Articles Published in JVIRand CVIR’’ (over a period of one year) [1]. Although wesupport any initiative to improve the quality of paperspublished in JVIR and CVIR, we feel that this paper gives awrong impression of the present status of the quality ofcurrent interventional literature. The authors state in theirintroduction, ‘‘We performed this investigation of thecurrent interventional literature to assess the quality of thepublished studies in this field.’’ However, to keep abreastof all developments in interventional radiology, it is nec-essary to expand the range of literature beyond JVIR andCVIR. High-quality interventional radiology papers,including randomized control trials, are most often sub-mitted and published elsewhere; they appear in the NewEngland Journal of Medicine, Lancet, JAMA, Circulation,and other high-indexed journals. The enormous impactfactor of these journals still play an important role atacademic careers. So, drawing conclusions about thequality of interventional radiology literature based solelyon JVIR and CVIR can lead to misconceptions. Undoubt-edly high-quality randomized control trials in interven-tional radiology have been performed for vertebroplasty,UAE, iliac stenting, EVAR, renal stenting, carotid stenting,SFA stenting, and drug-eluting balloons, to mention but afew, of which almost all have been published in one of theaforementioned top journals. Not recognizing this factleads to a damaging impression of interventional radiology,and furthermore, no tribute is paid to those whose effortshave been invested in these trials. The main issue is not thequality of papers in CVIR and JVIR but, rather, their lowerimpact factor. A pivotal reason for this is the AtlanticOcean or, to be more precise, the lack of a common globalinterventional radiology spirit across the ocean. Cross-references between JVIR and CVIR, or, rather, the UnitedStates and Europe, are rare, and most papers in thesejournals mainly quote work performed on their own con-tinent, often overlooking relevant papers overseas. Achange in this practice would certainly improve the citationindex of both journals. A number of European universitieshave become aware of the issue of impact factor and havesubsequently, very wisely, switched from the citation indexto the Hirsch index, which calculates the significance of thetotal scientific work of an author by looking at the numberof citations of all papers of an author. Even a paper pub-lished in a lower-ranking journal can be very important andtherefore generate many citations. The opposite is also true,however; not all highly ranked journals publish importantpapers only.A very interesting article by John P. A. Ionnidis, ‘‘WhyMost Published Research Findings Are False,’’ was pub-lished in 2005 [2]. He discusses the most crucial flaws inresearch: bias, proxy endpoints, insufficient power,reporting of only positive data, bad study design, incorrectstudy design, missing data, short follow-up, and low sta-tistical power. Some of these flaws can also be found in thepaper by Meyer et al., as well as in other papers publishedin JVIR and CVIR.Meyer et al. report on the quality of articles published inJVIR and CVIR during the course of 1 year. The two mainconclusions of their paper, besides the incorrect assessmentof the general quality of interventional radiology papers, asdiscussed above, are that (i) papers published in JVIR areJ. A. Reekers (&)  S. BipatDepartment of Radiology, AMC, University of Amsterdam,1066 EA Amsterdam, The Netherlandse-mail: j.a.reekers@amc.uva.nl123Cardiovasc Intervent Radiol (2010) 33:1–2DOI 10.1007/s00270-009-9768-3of a higher quality compared to papers published in CVIR,and (ii) articles published in both journals display sub-stantial weaknesses.These conclusions do not seem to be scientifically cor-rect. For the overall comparison of the journals, total scoreswere calculated for each article, the results of which werecompared between the two journals. However, if each itemwere evaluated separately, no difference would be noticed.Figure 1 in the paper in JVIR [1] shows that the proportionsof outcomes for most of the consort criteria were compa-rable in both journals. It is only the summation of scoresthat suggests a difference.Moreover, Meyer et al. did not take into account thetypes of studies. Not all items are applicable to all studies,e.g., as some items can only be addressed in randomizedcontrolled trials, they will always have a higher level ofevidence. It therefore seems appropriate that (i) only resultsfor the same item are compared and (ii) the types of studiesare reported. We wonder whether the differences wouldstill be significant if the authors had reported the findings asstated above.Furthermore, it remains open whether their p-valueswere obtained from the Wilcoxon rank-sum test or Stu-dent’s t-test, as it is also not clear why the authors statedmean values when performing a nonparametric test.Another issue is that assessment of the quality of papersshould always be done by two reviewers independently [3].Although Meyer et al. state that each investigator inde-pendently reviewed papers, it seems that each observerreviewed six issues of JVIR and three issues of CVIR. Someof the CONSORT criteria could be subjectively interpreted,as authors stated that there was ambiguity or uncertainty inscoring. All scores assigned by reviewer 1 were lower thanthose by reviewer 2. Although the authors state that this is aminor issue, these differences were found to be significant,and it is therefore not clear whether reviewer 1 conse-quently assigned these findings lower scores or reviewer 1had more studies from CVIR with lower scores (no data onthe number of articles per reviewer are reported). It is moreor less customary to assess all papers independently, andnot a selection. Therefore it is an important matter ofconcern that both observers did not perform this procedureappropriately.The paper is a good illustration, although perhapsunintentionally so, of how ambiguous an interventionalradiology paper can be in scientific terms.Recognizing the real problems of lower impact factorand minimal trans-Atlantic recognition with minimal cross-fertilization might have been a much better starting pointfor examining the quality of interventional radiologypapers published in both journals. CIRSE has recognizedfor years that education in medical statistics, good clinicalpractice, and evidence-based medicine is an important andlong-term investment to produce better science. At everyannual CIRSE meeting small-scale basic courses on thesetopics are available. Rather than conveying a productivemessage to improve the quality of interventional radiologypublications in both journals, the attitude of ‘‘them and us’’has been adopted. An unbiased bilateral discussion aboutscientific guidelines and strategic planning between theJVIR and the CVIR editorial boards could be the first steptoward bringing both journals to a higher scientific level.Maybe one day this could finally lead to a prominentlyranked journal dedicated to interventional radiologyexclusively serving the needs of global interventionalradiology. It is now time to go farther than our ownbackyards and to stop looking at interventional radiologypapers and journals from a watchtower.Open Access This article is distributed under the terms of theCreative Commons Attribution Noncommercial License which per-mits any noncommercial use, distribution, and reproduction in anymedium, provided the original author(s) and source are credited.References1. Meyer J, Nsouli-Maktabi H, Spies J (2009) Quality of interven-tional radiology literature: a review of articles published in JVIRand CVIR. Vasc Interv Radiol 20:1271–12762. Ioannides JP (2005) Why most published research findings arefalse. PLoS Med 2:e1243. Higgins JPT, Green S (eds) (2009) Cochrane handbook for systematicreviews of interventions. Version 5.0.2. Wiley, New York2 J. A. Reekers, S. Bipat: Quality of Interventional Radiology Journals and Papers123

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EDITORIAL / OPINION
Quality of Interventional Radiology Journals and Papers
J. A. Reekers • S. Bipat
Published online: 5 December 2009
 The Author(s) 2009. This article is published with open access at Springerlink.com
We read with great interest the paper recently published in
Journal of Vascular and Interventional Radiology (JVIR),
by Meyer et al., entitled ‘‘Quality of Interventional Radi-
ology Literature: A Review of Articles Published in JVIR
and CVIR’’ (over a period of one year) [1]. Although we
support any initiative to improve the quality of papers
published in JVIR and CVIR, we feel that this paper gives a
wrong impression of the present status of the quality of
current interventional literature. The authors state in their
introduction, ‘‘We performed this investigation of the
current interventional literature to assess the quality of the
published studies in this field.’’ However, to keep abreast
of all developments in interventional radiology, it is nec-
essary to expand the range of literature beyond JVIR and
CVIR. High-quality interventional radiology papers,
including randomized control trials, are most often sub-
mitted and published elsewhere; they appear in the New
England Journal of Medicine, Lancet, JAMA, Circulation,
and other high-indexed journals. The enormous impact
factor of these journals still play an important role at
academic careers. So, drawing conclusions about the
quality of interventional radiology literature based solely
on JVIR and CVIR can lead to misconceptions. Undoubt-
edly high-quality randomized control trials in interven-
tional radiology have been performed for vertebroplasty,
UAE, iliac stenting, EVAR, renal stenting, carotid stenting,
SFA stenting, and drug-eluting balloons, to mention but a
few, of which almost all have been published in one of the
aforementioned top journals. Not recognizing this fact
leads to a damaging impression of interventional radiology,
and furthermore, no tribute is paid to those whose efforts
have been invested in these trials. The main issue is not the
quality of papers in CVIR and JVIR but, rather, their lower
impact factor. A pivotal reason for this is the Atlantic
Ocean or, to be more precise, the lack of a common global
interventional radiology spirit across the ocean. Cross-
references between JVIR and CVIR, or, rather, the United
States and Europe, are rare, and most papers in these
journals mainly quote work performed on their own con-
tinent, often overlooking relevant papers overseas. A
change in this practice would certainly improve the citation
index of both journals. A number of European universities
have become aware of the issue of impact factor and have
subsequently, very wisely, switched from the citation index
to the Hirsch index, which calculates the significance of the
total scientific work of an author by looking at the number
of citations of all papers of an author. Even a paper pub-
lished in a lower-ranking journal can be very important and
therefore generate many citations. The opposite is also true,
however; not all highly ranked journals publish important
papers only.
A very interesting article by John P. A. Ionnidis, ‘‘Why
Most Published Research Findings Are False,’’ was pub-
lished in 2005 [2]. He discusses the most crucial flaws in
research: bias, proxy endpoints, insufficient power,
reporting of only positive data, bad study design, incorrect
study design, missing data, short follow-up, and low sta-
tistical power. Some of these flaws can also be found in the
paper by Meyer et al., as well as in other papers published
in JVIR and CVIR.
Meyer et al. report on the quality of articles published in
JVIR and CVIR during the course of 1 year. The two main
conclusions of their paper, besides the incorrect assessment
of the general quality of interventional radiology papers, as
discussed above, are that (i) papers published in JVIR are
J. A. Reekers (&)  S. Bipat
Department of Radiology, AMC, University of Amsterdam,
1066 EA Amsterdam, The Netherlands
e-mail: j.a.reekers@amc.uva.nl
123
Cardiovasc Intervent Radiol (2010) 33:1–2
DOI 10.1007/s00270-009-9768-3
of a higher quality compared to papers published in CVIR,
and (ii) articles published in both journals display sub-
stantial weaknesses.
These conclusions do not seem to be scientifically cor-
rect. For the overall comparison of the journals, total scores
were calculated for each article, the results of which were
compared between the two journals. However, if each item
were evaluated separately, no difference would be noticed.
Figure 1 in the paper in JVIR [1] shows that the proportions
of outcomes for most of the consort criteria were compa-
rable in both journals. It is only the summation of scores
that suggests a difference.
Moreover, Meyer et al. did not take into account the
types of studies. Not all items are applicable to all studies,
e.g., as some items can only be addressed in randomized
controlled trials, they will always have a higher level of
evidence. It therefore seems appropriate that (i) only results
for the same item are compared and (ii) the types of studies
are reported. We wonder whether the differences would
still be significant if the authors had reported the findings as
stated above.
Furthermore, it remains open whether their p-values
were obtained from the Wilcoxon rank-sum test or Stu-
dent’s t-test, as it is also not clear why the authors stated
mean values when performing a nonparametric test.
Another issue is that assessment of the quality of papers
should always be done by two reviewers independently [3].
Although Meyer et al. state that each investigator inde-
pendently reviewed papers, it seems that each observer
reviewed six issues of JVIR and three issues of CVIR. Some
of the CONSORT criteria could be subjectively interpreted,
as authors stated that there was ambiguity or uncertainty in
scoring. All scores assigned by reviewer 1 were lower than
those by reviewer 2. Although the authors state that this is a
minor issue, these differences were found to be significant,
and it is therefore not clear whether reviewer 1 conse-
quently assigned these findings lower scores or reviewer 1
had more studies from CVIR with lower scores (no data on
the number of articles per reviewer are reported). It is more
or less customary to assess all papers independently, and
not a selection. Therefore it is an important matter of
concern that both observers did not perform this procedure
appropriately.
The paper is a good illustration, although perhaps
unintentionally so, of how ambiguous an interventional
radiology paper can be in scientific terms.
Recognizing the real problems of lower impact factor
and minimal trans-Atlantic recognition with minimal cross-
fertilization might have been a much better starting point
for examining the quality of interventional radiology
papers published in both journals. CIRSE has recognized
for years that education in medical statistics, good clinical
practice, and evidence-based medicine is an important and
long-term investment to produce better science. At every
annual CIRSE meeting small-scale basic courses on these
topics are available. Rather than conveying a productive
message to improve the quality of interventional radiology
publications in both journals, the attitude of ‘‘them and us’’
has been adopted. An unbiased bilateral discussion about
scientific guidelines and strategic planning between the
JVIR and the CVIR editorial boards could be the first step
toward bringing both journals to a higher scientific level.
Maybe one day this could finally lead to a prominently
ranked journal dedicated to interventional radiology
exclusively serving the needs of global interventional
radiology. It is now time to go farther than our own
backyards and to stop looking at interventional radiology
papers and journals from a watchtower.
Open Access This article is distributed under the terms of the
Creative Commons Attribution Noncommercial License which per-
mits any noncommercial use, distribution, and reproduction in any
medium, provided the original author(s) and source are credited.
References
1. Meyer J, Nsouli-Maktabi H, Spies J (2009) Quality of interven-
tional radiology literature: a review of articles published in JVIR
and CVIR. Vasc Interv Radiol 20:1271–1276
2. Ioannides JP (2005) Why most published research findings are
false. PLoS Med 2:e124
3. Higgins JPT, Green S (eds) (2009) Cochrane handbook for systematic
reviews of interventions. Version 5.0.2. Wiley, New York
2 J. A. Reekers, S. Bipat: Quality of Interventional Radiology Journals and Papers
123


UvA-DARE

UvA-DARE is a service provided by the library of the University of Amsterdam (http://dare.uva.nl)
UvA-DARE (Digital Academic Repository)
Quality of Interventional Radiology Journals and Papers
Reekers, J.A.; Bipat, S.
Published in:
Cardiovascular and interventional radiology
DOI:
10.1007/s00270-009-9768-3
Link to publication
Citation for published version (APA):
Reekers, J. A., & Bipat, S. (2010). Quality of Interventional Radiology Journals and Papers. Cardiovascular and
interventional radiology, 33(1), 1-2. https://doi.org/10.1007/s00270-009-9768-3
General rights
It is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s),
other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons).
Disclaimer/Complaints regulations
If you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating
your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask
the Library: https://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam,
The Netherlands. You will be contacted as soon as possible.
Download date: 04 Feb 2021
EDITORIAL / OPINION
Quality of Interventional Radiology Journals and Papers
J. A. Reekers • S. Bipat
Published online: 5 December 2009
 The Author(s) 2009. This article is published with open access at Springerlink.com
We read with great interest the paper recently published in
Journal of Vascular and Interventional Radiology (JVIR),
by Meyer et al., entitled ‘‘Quality of Interventional Radi-
ology Literature: A Review of Articles Published in JVIR
and CVIR’’ (over a period of one year) [1]. Although we
support any initiative to improve the quality of papers
published in JVIR and CVIR, we feel that this paper gives a
wrong impression of the present status of the quality of
current interventional literature. The authors state in their
introduction, ‘‘We performed this investigation of the
current interventional literature to assess the quality of the
published studies in this field.’’ However, to keep abreast
of all developments in interventional radiology, it is nec-
essary to expand the range of literature beyond JVIR and
CVIR. High-quality interventional radiology papers,
including randomized control trials, are most often sub-
mitted and published elsewhere; they appear in the New
England Journal of Medicine, Lancet, JAMA, Circulation,
and other high-indexed journals. The enormous impact
factor of these journals still play an important role at
academic careers. So, drawing conclusions about the
quality of interventional radiology literature based solely
on JVIR and CVIR can lead to misconceptions. Undoubt-
edly high-quality randomized control trials in interven-
tional radiology have been performed for vertebroplasty,
UAE, iliac stenting, EVAR, renal stenting, carotid stenting,
SFA stenting, and drug-eluting balloons, to mention but a
few, of which almost all have been published in one of the
aforementioned top journals. Not recognizing this fact
leads to a damaging impression of interventional radiology,
and furthermore, no tribute is paid to those whose efforts
have been invested in these trials. The main issue is not the
quality of papers in CVIR and JVIR but, rather, their lower
impact factor. A pivotal reason for this is the Atlantic
Ocean or, to be more precise, the lack of a common global
interventional radiology spirit across the ocean. Cross-
references between JVIR and CVIR, or, rather, the United
States and Europe, are rare, and most papers in these
journals mainly quote work performed on their own con-
tinent, often overlooking relevant papers overseas. A
change in this practice would certainly improve the citation
index of both journals. A number of European universities
have become aware of the issue of impact factor and have
subsequently, very wisely, switched from the citation index
to the Hirsch index, which calculates the significance of the
total scientific work of an author by looking at the number
of citations of all papers of an author. Even a paper pub-
lished in a lower-ranking journal can be very important and
therefore generate many citations. The opposite is also true,
however; not all highly ranked journals publish important
papers only.
A very interesting article by John P. A. Ionnidis, ‘‘Why
Most Published Research Findings Are False,’’ was pub-
lished in 2005 [2]. He discusses the most crucial flaws in
research: bias, proxy endpoints, insufficient power,
reporting of only positive data, bad study design, incorrect
study design, missing data, short follow-up, and low sta-
tistical power. Some of these flaws can also be found in the
paper by Meyer et al., as well as in other papers published
in JVIR and CVIR.
Meyer et al. report on the quality of articles published in
JVIR and CVIR during the course of 1 year. The two main
conclusions of their paper, besides the incorrect assessment
of the general quality of interventional radiology papers, as
discussed above, are that (i) papers published in JVIR are
J. A. Reekers (&)  S. Bipat
Department of Radiology, AMC, University of Amsterdam,
1066 EA Amsterdam, The Netherlands
e-mail: j.a.reekers@amc.uva.nl
123
Cardiovasc Intervent Radiol (2010) 33:1–2
DOI 10.1007/s00270-009-9768-3
of a higher quality compared to papers published in CVIR,
and (ii) articles published in both journals display sub-
stantial weaknesses.
These conclusions do not seem to be scientifically cor-
rect. For the overall comparison of the journals, total scores
were calculated for each article, the results of which were
compared between the two journals. However, if each item
were evaluated separately, no difference would be noticed.
Figure 1 in the paper in JVIR [1] shows that the proportions
of outcomes for most of the consort criteria were compa-
rable in both journals. It is only the summation of scores
that suggests a difference.
Moreover, Meyer et al. did not take into account the
types of studies. Not all items are applicable to all studies,
e.g., as some items can only be addressed in randomized
controlled trials, they will always have a higher level of
evidence. It therefore seems appropriate that (i) only results
for the same item are compared and (ii) the types of studies
are reported. We wonder whether the differences would
still be significant if the authors had reported the findings as
stated above.
Furthermore, it remains open whether their p-values
were obtained from the Wilcoxon rank-sum test or Stu-
dent’s t-test, as it is also not clear why the authors stated
mean values when performing a nonparametric test.
Another issue is that assessment of the quality of papers
should always be done by two reviewers independently [3].
Although Meyer et al. state that each investigator inde-
pendently reviewed papers, it seems that each observer
reviewed six issues of JVIR and three issues of CVIR. Some
of the CONSORT criteria could be subjectively interpreted,
as authors stated that there was ambiguity or uncertainty in
scoring. All scores assigned by reviewer 1 were lower than
those by reviewer 2. Although the authors state that this is a
minor issue, these differences were found to be significant,
and it is therefore not clear whether reviewer 1 conse-
quently assigned these findings lower scores or reviewer 1
had more studies from CVIR with lower scores (no data on
the number of articles per reviewer are reported). It is more
or less customary to assess all papers independently, and
not a selection. Therefore it is an important matter of
concern that both observers did not perform this procedure
appropriately.
The paper is a good illustration, although perhaps
unintentionally so, of how ambiguous an interventional
radiology paper can be in scientific terms.
Recognizing the real problems of lower impact factor
and minimal trans-Atlantic recognition with minimal cross-
fertilization might have been a much better starting point
for examining the quality of interventional radiology
papers published in both journals. CIRSE has recognized
for years that education in medical statistics, good clinical
practice, and evidence-based medicine is an important and
long-term investment to produce better science. At every
annual CIRSE meeting small-scale basic courses on these
topics are available. Rather than conveying a productive
message to improve the quality of interventional radiology
publications in both journals, the attitude of ‘‘them and us’’
has been adopted. An unbiased bilateral discussion about
scientific guidelines and strategic planning between the
JVIR and the CVIR editorial boards could be the first step
toward bringing both journals to a higher scientific level.
Maybe one day this could finally lead to a prominently
ranked journal dedicated to interventional radiology
exclusively serving the needs of global interventional
radiology. It is now time to go farther than our own
backyards and to stop looking at interventional radiology
papers and journals from a watchtower.
Open Access This article is distributed under the terms of the
Creative Commons Attribution Noncommercial License which per-
mits any noncommercial use, distribution, and reproduction in any
medium, provided the original author(s) and source are credited.
References
1. Meyer J, Nsouli-Maktabi H, Spies J (2009) Quality of interven-
tional radiology literature: a review of articles published in JVIR
and CVIR. Vasc Interv Radiol 20:1271–1276
2. Ioannides JP (2005) Why most published research findings are
false. PLoS Med 2:e124
3. Higgins JPT, Green S (eds) (2009) Cochrane handbook for systematic
reviews of interventions. Version 5.0.2. Wiley, New York
2 J. A. Reekers, S. Bipat: Quality of Interventional Radiology Journals and Papers
123


UvA-DARE is a service provided by the library of the University of Amsterdam (https://dare.uva.nl)UvA-DARE (Digital Academic Repository)Quality of Interventional Radiology Journals and PapersReekers, J.A.; Bipat, S.DOI10.1007/s00270-009-9768-3Publication date2010Document VersionFinal published versionPublished inCardiovascular and interventional radiologyLink to publicationCitation for published version (APA):Reekers, J. A., & Bipat, S. (2010). Quality of Interventional Radiology Journals and Papers.Cardiovascular and interventional radiology, 33(1), 1-2. https://doi.org/10.1007/s00270-009-9768-3General rightsIt is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s)and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an opencontent license (like Creative Commons).Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, pleaselet the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the materialinaccessible and/or remove it from the website. Please Ask the Library: https://uba.uva.nl/en/contact, or a letterto: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. Youwill be contacted as soon as possible.Download date:25 Jul 2022EDITORIAL / OPINIONQuality of Interventional Radiology Journals and PapersJ. A. Reekers • S. BipatPublished online: 5 December 2009 The Author(s) 2009. This article is published with open access at Springerlink.comWe read with great interest the paper recently published inJournal of Vascular and Interventional Radiology (JVIR),by Meyer et al., entitled ‘‘Quality of Interventional Radi-ology Literature: A Review of Articles Published in JVIRand CVIR’’ (over a period of one year) [1]. Although wesupport any initiative to improve the quality of paperspublished in JVIR and CVIR, we feel that this paper gives awrong impression of the present status of the quality ofcurrent interventional literature. The authors state in theirintroduction, ‘‘We performed this investigation of thecurrent interventional literature to assess the quality of thepublished studies in this field.’’ However, to keep abreastof all developments in interventional radiology, it is nec-essary to expand the range of literature beyond JVIR andCVIR. High-quality interventional radiology papers,including randomized control trials, are most often sub-mitted and published elsewhere; they appear in the NewEngland Journal of Medicine, Lancet, JAMA, Circulation,and other high-indexed journals. The enormous impactfactor of these journals still play an important role atacademic careers. So, drawing conclusions about thequality of interventional radiology literature based solelyon JVIR and CVIR can lead to misconceptions. Undoubt-edly high-quality randomized control trials in interven-tional radiology have been performed for vertebroplasty,UAE, iliac stenting, EVAR, renal stenting, carotid stenting,SFA stenting, and drug-eluting balloons, to mention but afew, of which almost all have been published in one of theaforementioned top journals. Not recognizing this factleads to a damaging impression of interventional radiology,and furthermore, no tribute is paid to those whose effortshave been invested in these trials. The main issue is not thequality of papers in CVIR and JVIR but, rather, their lowerimpact factor. A pivotal reason for this is the AtlanticOcean or, to be more precise, the lack of a common globalinterventional radiology spirit across the ocean. Cross-references between JVIR and CVIR, or, rather, the UnitedStates and Europe, are rare, and most papers in thesejournals mainly quote work performed on their own con-tinent, often overlooking relevant papers overseas. Achange in this practice would certainly improve the citationindex of both journals. A number of European universitieshave become aware of the issue of impact factor and havesubsequently, very wisely, switched from the citation indexto the Hirsch index, which calculates the significance of thetotal scientific work of an author by looking at the numberof citations of all papers of an author. Even a paper pub-lished in a lower-ranking journal can be very important andtherefore generate many citations. The opposite is also true,however; not all highly ranked journals publish importantpapers only.A very interesting article by John P. A. Ionnidis, ‘‘WhyMost Published Research Findings Are False,’’ was pub-lished in 2005 [2]. He discusses the most crucial flaws inresearch: bias, proxy endpoints, insufficient power,reporting of only positive data, bad study design, incorrectstudy design, missing data, short follow-up, and low sta-tistical power. Some of these flaws can also be found in thepaper by Meyer et al., as well as in other papers publishedin JVIR and CVIR.Meyer et al. report on the quality of articles published inJVIR and CVIR during the course of 1 year. The two mainconclusions of their paper, besides the incorrect assessmentof the general quality of interventional radiology papers, asdiscussed above, are that (i) papers published in JVIR areJ. A. Reekers (&)  S. BipatDepartment of Radiology, AMC, University of Amsterdam,1066 EA Amsterdam, The Netherlandse-mail: j.a.reekers@amc.uva.nl123Cardiovasc Intervent Radiol (2010) 33:1–2DOI 10.1007/s00270-009-9768-3of a higher quality compared to papers published in CVIR,and (ii) articles published in both journals display sub-stantial weaknesses.These conclusions do not seem to be scientifically cor-rect. For the overall comparison of the journals, total scoreswere calculated for each article, the results of which werecompared between the two journals. However, if each itemwere evaluated separately, no difference would be noticed.Figure 1 in the paper in JVIR [1] shows that the proportionsof outcomes for most of the consort criteria were compa-rable in both journals. It is only the summation of scoresthat suggests a difference.Moreover, Meyer et al. did not take into account thetypes of studies. Not all items are applicable to all studies,e.g., as some items can only be addressed in randomizedcontrolled trials, they will always have a higher level ofevidence. It therefore seems appropriate that (i) only resultsfor the same item are compared and (ii) the types of studiesare reported. We wonder whether the differences wouldstill be significant if the authors had reported the findings asstated above.Furthermore, it remains open whether their p-valueswere obtained from the Wilcoxon rank-sum test or Stu-dent’s t-test, as it is also not clear why the authors statedmean values when performing a nonparametric test.Another issue is that assessment of the quality of papersshould always be done by two reviewers independently [3].Although Meyer et al. state that each investigator inde-pendently reviewed papers, it seems that each observerreviewed six issues of JVIR and three issues of CVIR. Someof the CONSORT criteria could be subjectively interpreted,as authors stated that there was ambiguity or uncertainty inscoring. All scores assigned by reviewer 1 were lower thanthose by reviewer 2. Although the authors state that this is aminor issue, these differences were found to be significant,and it is therefore not clear whether reviewer 1 conse-quently assigned these findings lower scores or reviewer 1had more studies from CVIR with lower scores (no data onthe number of articles per reviewer are reported). It is moreor less customary to assess all papers independently, andnot a selection. Therefore it is an important matter ofconcern that both observers did not perform this procedureappropriately.The paper is a good illustration, although perhapsunintentionally so, of how ambiguous an interventionalradiology paper can be in scientific terms.Recognizing the real problems of lower impact factorand minimal trans-Atlantic recognition with minimal cross-fertilization might have been a much better starting pointfor examining the quality of interventional radiologypapers published in both journals. CIRSE has recognizedfor years that education in medical statistics, good clinicalpractice, and evidence-based medicine is an important andlong-term investment to produce better science. At everyannual CIRSE meeting small-scale basic courses on thesetopics are available. Rather than conveying a productivemessage to improve the quality of interventional radiologypublications in both journals, the attitude of ‘‘them and us’’has been adopted. An unbiased bilateral discussion aboutscientific guidelines and strategic planning between theJVIR and the CVIR editorial boards could be the first steptoward bringing both journals to a higher scientific level.Maybe one day this could finally lead to a prominentlyranked journal dedicated to interventional radiologyexclusively serving the needs of global interventionalradiology. It is now time to go farther than our ownbackyards and to stop looking at interventional radiologypapers and journals from a watchtower.Open Access This article is distributed under the terms of theCreative Commons Attribution Noncommercial License which per-mits any noncommercial use, distribution, and reproduction in anymedium, provided the original author(s) and source are credited.References1. Meyer J, Nsouli-Maktabi H, Spies J (2009) Quality of interven-tional radiology literature: a review of articles published in JVIRand CVIR. Vasc Interv Radiol 20:1271–12762. Ioannides JP (2005) Why most published research findings arefalse. PLoS Med 2:e1243. Higgins JPT, Green S (eds) (2009) Cochrane handbook for systematicreviews of interventions. Version 5.0.2. Wiley, New York2 J. A. Reekers, S. Bipat: Quality of Interventional Radiology Journals and Papers123

HigginsJPT,GreenS(eds)(2009)Cochranehandbookforsystematic reviews of interventions. Version 5.0.2.

Quality of interventional radiology literature: a review of articles published

Why most published research ﬁndings are false.

Quality of Interventional Radiology Journals and Papers

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