Advertisement

Transparent Communication of Radiology Research

Reporting Guidelines and Beyond
  • Ying Lu
    Correspondence
    Address correspondence to: Y.L.
    Affiliations
    Department of Health Research and Policy, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA

    VA Cooperative Studies Program Coordinating Center, VA Palo Alto Health Care System, Palo Alto, California
    Search for articles by this author
  • John P.A. Ioannidis
    Affiliations
    Department of Health Research and Policy, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA

    Department of Medicine, Stanford University School of Medicine, Stanford, California
    Search for articles by this author
Published:March 23, 2016DOI:https://doi.org/10.1016/j.acra.2016.02.009
      Radiology research aims to improve patient care, quality of life, and longevity. To achieve this goal, we must transparently disseminate research findings and provide sufficient information to understand their validity and generalizability. The use of study reporting guidelines has been found to be associated with higher quality and increased citations in radiology journals (
      • Tunis A.S.
      • McInnes M.D.F.
      • Hanna R.
      • et al.
      Association of study quality with completeness of reporting: have completeness of reporting and quality of systematic reviews and meta-analyses in major radiology journals changed since publication of the PRISMA statement?.
      ,
      • Van der Pol C.B.
      • McInnes M.D.F.
      • Petrcich W.
      • et al.
      Is quality and completeness of reporting of systematic reviews and meta-analyses published in high impact radiology journals associated with citation rates?.
      ) and with improved reporting of information (
      • Barnes C.
      • Boutron I.
      • Giraudeau B.
      • et al.
      Impact of an online writing aid tool for writing a randomized trial report: the COBWEB (Consort-based WEB tool) randomized controlled trial.
      ) for some study designs. A long and expanding list of developed reporting guidelines is accessible from the Enhancing the Quality and Transparency of Health Research (EQUATOR) website (http://www.equator-network.org). In this issue, Cronin and Rawson (
      • Cronin P.
      • Rawson J.V.
      Review of research reporting guidelines for radiology researchers.
      ) provide a comprehensive review of reporting guidelines crucially relevant to radiology researchers.
      The hallmark of these guidelines is that they are developed according to systematic approaches, rather than just expert opinions. They can also be updated when new evidence or concerns arise. A good example is the development of Consolidated Standards of Reporting Trials (CONSORT) (). A first version was published in 1996 and then updated in 2001. Even after the 2001 revision, growing evidence highlighted new concerns regarding the reporting of randomized controlled trials, such as selective outcome reporting (
      • Chan A.W.
      • Hróbjartsson A.
      • Haahr M.T.
      • et al.
      Empirical evidence for selective reporting of outcomes in randomized trials: comparison of protocols to published articles.
      ,
      • Al-Marzouki S.
      • Roberts I.
      • Evans S.
      • et al.
      Selective reporting in clinical trials: analysis of trial protocols accepted by the Lancet.
      ,
      • Dwan K.
      • Altman D.G.
      • Arnaiz J.A.
      • et al.
      Systematic review of the empirical evidence of study publication bias and outcome reporting bias.
      ). Therefore, a CONSORT Group meeting was convened in January 2007. Members of the CONSORT Group aggregated and synthesized relevant evidence regarding possible new checklist items. After seven major iterations and community feedback, the Group produced a new CONSORT statement in 2010 (
      • Schulz K.F.
      • Altman D.G.
      • Moher D.
      • et al.
      CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials.
      ). Still, this version will probably not be the final, immutable one.
      To understand the current impact of these guidelines on radiology journals, we reviewed the “Instructions to Authors” section of the top-ranked radiology, nuclear medicine, and imaging journals with 2014 H-index above 100 by Scimago (http://www.scimagojr.com/journalrank.php?area=0&category=2741&country=all&year=2014&order=h&min=0&min_type=cd). After excluding two medical physics journals and including Academic Radiology, we analyzed 14 journals. Among them, only one journal provides information about EQUATOR. Five journals mentioned CONSORT; four mentioned STAndards for Reporting of Diagnostic accuracy, Preferred Reporting Items for Systematic Reviews and Meta-Analysis, and National Institutes of Health Principles and Guidelines for Reporting Preclinical Research; and two mentioned REporting recommendations for tumor MARKer prognostic studies, even though all these journals could publish studies where these guidelines might be relevant. All journals indicated that they follow the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals by the International Committee of Medical Journal Editors. No journal has the complete list of reporting guidelines reviewed in Cronin and Rawson (
      • Cronin P.
      • Rawson J.V.
      Review of research reporting guidelines for radiology researchers.
      ).
      The quality of scientific reports rests not only with authors but also with reviewers and editors. Increasingly, journals provide access to reporting guidelines to referees. However, this is not a universal practice. Journals could include specific questions to reviewers about compliance with reporting guidelines relevant to the study. Examining systematically each and all of the items that are essential in reporting a study, the reviewers may perform a more comprehensive and informative review.
      Reporting findings is often the last step in a scientific research life cycle. Thus, rigorous reporting guidelines do not necessarily make a study better after the completion of most research activities. These guidelines do give readers information to better judge the published research (
      • The PLOS Medicine Editors
      Better reporting of scientific studies: why it matters.
      ). However, scientific principles and sound judgment have to be applied from the very beginning and through every step in the research process. Interestingly, Radiology has placed reporting guidelines and EQUATOR information in the “Before the Study” section in their instruction to authors (http://pubs.rsna.org/page/radiology/pia/author-toolkit#before_the_study). Reporting guidelines can be useful resources for investigators even before beginning their study.
      Although Cronin and Rawson (
      • Cronin P.
      • Rawson J.V.
      Review of research reporting guidelines for radiology researchers.
      ) provided a comprehensive review of many research reporting guidelines, there are still guidelines developed for radiologists that were not included in their review. When we search clinical areas of “Radiology” in the EQUATOR Network, 22 reporting guidelines are identified, most of them for subspecialty research, such as Standards of reporting for MRI-targeted biopsy studies of the prostate (
      • Moore C.M.
      • Kasivisvanathan V.
      • Eggener S.
      • et al.
      START Consortium
      Standards of reporting for MRI-targeted biopsy studies (START) of the prostate: recommendations from an International Working Group.
      ), or guidelines for reporting a functional magnetic resonance imaging study (
      • Poldrack R.A.
      • Fletcher P.C.
      • Henson R.N.
      • et al.
      Guidelines for reporting an fMRI study.
      ), etc. Often times, a research design may have design elements that are covered under different reporting guidelines. Because medical research evolves rapidly and medical fields are very broad, there is a need for the development of new guidelines, and this may be particularly true for radiology where new imaging methods evolve. An important resource in EQUATOR is the guidance to develop guidelines (
      • Moher D.
      • Schulz K.F.
      • Simera I.
      • et al.
      Guidance for developers of health research reporting guidelines.
      ). There are opportunities for radiologists to contribute further to the development of reporting guidelines for the needs of radiology research.
      Moreover, many potential selection and other biases in imaging are difficult to study (
      • Siontis G.C.
      • Patsopoulos N.A.
      • Vlahos A.P.
      • et al.
      Selection and presentation of imaging figures in the medical literature.
      ), because elliptical study reporting does not allow probing how common these problems are. Improved reporting and capturing the elements that are most crucial for each radiology study may make these biases better understood and easier to fix.
      One collateral risk of the wider enforcement of reporting guidelines is that investigators may feel compelled to report a misleadingly “nice” picture about the design or conduct of their study. It is unknown how frequent this normative response is. Accordingly, a new wave of guidelines aims at providing guidance for reporting protocol designs, rather than just manuscripts communicating the results of already completed research. There is also a wider movement to enhance transparency through preregistration of studies and sharing of protocols and raw data. These activities may complement more accurate and standardized study reporting. In the diagnostic literature, preregistration and sharing are still rare (
      • Rifai N.
      • Bossuyt P.M.
      • Ioannidis J.P.
      • et al.
      Registering diagnostic and prognostic trials of tests: is it the right thing to do?.
      ). However, systemic changes are contemplated. For example, recently, the International Committee of Medical Journal Editors updated their 2015 Recommendations (http://www.icmje.org/icmje-recommendations.pdf) and proposed a requirement to share data generated by interventional clinical trials as a condition of consideration for publication (
      • Taichman D.B.
      • Backus J.
      • Baethge C.
      • et al.
      Sharing clinical trial data: a proposal from the International Committee of Medical Journal Editors.
      ). This recommendation is currently open for public feedback at http://www.icmje.org until April 18, 2016. An interventional clinical trial is defined as “ANY research project that prospectively assigns people or a group of people to an intervention, with or without comparison or control groups, to study the cause-and-effect relationship between a health related intervention and a health outcome.” Most radiological studies should be encompassed under this definition. If such paradigm changes occur, there will be new needs for data sharing guidelines for radiology research to be developed by academic radiologists.
      In summary, we welcome the work of Cronin and Rawson. We hope this article will not only create awareness, but also improve reporting compliance and increase radiologist participation in development of future reporting guidelines and wider efforts to improve transparency in research efforts.

      References

        • Tunis A.S.
        • McInnes M.D.F.
        • Hanna R.
        • et al.
        Association of study quality with completeness of reporting: have completeness of reporting and quality of systematic reviews and meta-analyses in major radiology journals changed since publication of the PRISMA statement?.
        Radiology. 2013; 269: 413-426
        • Van der Pol C.B.
        • McInnes M.D.F.
        • Petrcich W.
        • et al.
        Is quality and completeness of reporting of systematic reviews and meta-analyses published in high impact radiology journals associated with citation rates?.
        PLoS ONE. 2015; 10: e0119892https://doi.org/10.1371/journal.pone.0119892
        • Barnes C.
        • Boutron I.
        • Giraudeau B.
        • et al.
        Impact of an online writing aid tool for writing a randomized trial report: the COBWEB (Consort-based WEB tool) randomized controlled trial.
        BMC Med. 2015; 13: 221https://doi.org/10.1186/s12916-015-0460-y
        • Cronin P.
        • Rawson J.V.
        Review of research reporting guidelines for radiology researchers.
        Acad Radiol. 2016; https://doi.org/10.1016/j.acra.2016.01.004
        • CONSORT-Statement.org
        About CONSORT History.
        (Available:)
        • Chan A.W.
        • Hróbjartsson A.
        • Haahr M.T.
        • et al.
        Empirical evidence for selective reporting of outcomes in randomized trials: comparison of protocols to published articles.
        JAMA. 2004; 291: 2457-2465
        • Al-Marzouki S.
        • Roberts I.
        • Evans S.
        • et al.
        Selective reporting in clinical trials: analysis of trial protocols accepted by the Lancet.
        Lancet. 2008; 372: 201
        • Dwan K.
        • Altman D.G.
        • Arnaiz J.A.
        • et al.
        Systematic review of the empirical evidence of study publication bias and outcome reporting bias.
        PLoS ONE. 2008; 3: e3081
        • Schulz K.F.
        • Altman D.G.
        • Moher D.
        • et al.
        CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials.
        Ann Int Med. 2010; 152: 726-732
        • The PLOS Medicine Editors
        Better reporting of scientific studies: why it matters.
        PLoS Med. 2013; 10: e1001504https://doi.org/10.1371/journal.pmed.1001504
        • Moore C.M.
        • Kasivisvanathan V.
        • Eggener S.
        • et al.
        • START Consortium
        Standards of reporting for MRI-targeted biopsy studies (START) of the prostate: recommendations from an International Working Group.
        Eur Urol. 2013; 64: 544-552
        • Poldrack R.A.
        • Fletcher P.C.
        • Henson R.N.
        • et al.
        Guidelines for reporting an fMRI study.
        Neuroimage. 2008; 40: 409-414
        • Moher D.
        • Schulz K.F.
        • Simera I.
        • et al.
        Guidance for developers of health research reporting guidelines.
        PLoS Med. 2010; 7: e1000217
        • Siontis G.C.
        • Patsopoulos N.A.
        • Vlahos A.P.
        • et al.
        Selection and presentation of imaging figures in the medical literature.
        PLoS ONE. 2010; 5: e10888
        • Rifai N.
        • Bossuyt P.M.
        • Ioannidis J.P.
        • et al.
        Registering diagnostic and prognostic trials of tests: is it the right thing to do?.
        Clin Chem. 2014; 60: 1146-1152
        • Taichman D.B.
        • Backus J.
        • Baethge C.
        • et al.
        Sharing clinical trial data: a proposal from the International Committee of Medical Journal Editors.
        JAMA. 2016; 315: 467-468https://doi.org/10.1001/jama.2015.18164