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Internationalization of the American Journal of Roentgenology: 1980–2002

¹ Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1088.
² AJR Editorial Office, Ste. 303, 101 S. Stratford Rd., Winston-Salem, NC 27104.

Received April 1, 2003; accepted after revision April 28, 1003.

 
Address correspondence to M. Y. Chen (mchen{at}wfubmc.edu).

Abstract

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OBJECTIVE. The objective of this study was to analyze trends in the number of articles from international authors submitted to or published by the American Journal of Roentgenology (AJR) between 1980 and 2002.

MATERIALS AND METHODS. More than 5000 articles published by the AJR during three 3-year periods (1980–1982, 1990–1992, and 2000–2002) were categorized by country of residence of the corresponding author, type of article, subject matter and age of patients, organ system, and radiologic technique. Additionally, 6202 manuscripts submitted to the AJR (1991–1992 and 2001–2002) were used to calculate the acceptance rates for the two 2-year periods.

RESULTS. The percentage of articles published by the AJR from international authors was 10% (158/1610) in 1980–1982, 25% (441/1788) in 1990–1992, and 37% (602/1624) in 2000–2002 (p < 0.0001). Japanese, South Korean, and German authors achieved the largest increases during the 22 years covered by our research, and Canada had the largest decrease. The increase in international articles at the AJR was accompanied by an absolute decrease in publications from authors in the United States. Nonetheless, during 2000–2002, the acceptance rate for major papers from authors in the United States was 45% and the acceptance rate for foreign authors was 31%. During 1990–1992, the acceptance rates for major papers were 33% and 27%, respectively.

CONCLUSION. The contents of the AJR reflect a continually increasing number of international articles during the past two decades.

Introduction

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Nine years ago, two of the authors of this article studied international contributions to the American Journal of Roentgenology (AJR) and described a trend toward increased contributions from all over the world and decreased contributions from the United States and Canada [1]. Since 2000, the AJR has each year received more submissions from corresponding authors who reside outside the United States than from those who reside in the United States [2, 3]. Increases in international contributions have been noted for both Radiology and the AJR [4]. Since the publication of our previous article, almost a decade has passed, and thus we are revisiting the trend of international contributions to radiology research at the AJR. To do this, we collected the most recent 3 full years of publications data at the AJR and compared them with the two 3-year data sets used in our previous article.

Materials and Methods

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All articles published in the AJR in the past 3 full years (January 2000–December 2002) were retrospectively reviewed and compared with similar data sets for two other 3-year periods (January 1980–December 1982 and January 1990–December 1992) [1]. Each article in the AJR was categorized by country and region of origin, type of article, subject matter and age of the patients, organ system, and radiologic technique. To analyze the data, we used Access software (Microsoft, Redmond, WA).

The types of articles were first classified into four categories: major papers, case reports, technical innovations, and editorials and reviews. Major papers were defined to include original reports. In 1994 and 1996, the AJR created new categories of articles, pictorial essays and original reports, respectively. To avoid confusion and maintain consistency, we grouped two types of AJR articles (major papers and original reports) under "major papers," the term used in our previous article [1]. Case reports were defined to include radiologic–pathologic conferences. Technical innovations were called technical notes before the mid 1990s. Editorials and reviews included perspectives, historical perspectives, editor's notebooks, reviews, opinions, centennial lectures, and commentaries. Articles published in the AJR as special articles, computers in radiology, research in radiology, and malpractice issues in radiology were all grouped as editorials and reviews. Letters to the editor were included in the data sets of the 1980s and 1990s but were excluded for the 2000–2002 period. Other contents such as cases of the day, meeting notes, photo pages, announcements, conference reports, book and software reviews, Medicine in American Art, and On the Viewbox were also excluded from this analysis.

The categories were then divided into human or experimental research. Human research was sub-classified as pediatric, adult, or mixed age. Technical innovations and editorial articles, many of which did not deal with age, were categorized as mixed age. Experimental research included cadavers, animals, and equipment.

We also analyzed each article according to the predominant organ system or anatomic area involved in the study. Categories included breast, cardiovascular, gastrointestinal or abdominal, hepatobiliary, genitourinary (including the retroperitoneum and obstetrics), musculoskeletal, neurologic or otolaryngologic (including the spine and head and neck), and pulmonary or thoracic. A miscellaneous category included studies that were difficult to classify as a specific organ system or studies involving multiple organ systems, such as whole-body imaging. Lesions in the aorta and its main branches were categorized as cardiovascular, and lesions in the peripheral vessels were categorized as miscellaneous. The category of hepatobiliary was used only for the period 2000–2002. For the 1980s and 1990s, research about the hepatobiliary tract was included in the gastrointestinal or abdominal category.

The radiologic technique used by each group of researchers was also categorized. Angiography included diagnostic angiography, venography, lymphangiography, and interventional studies in which cerebral, cardiac, or peripheral vasculature was studied. CT included conventional CT, helical CT, multidetector CT, electron beam CT, CT colonography, CT bronchography, and CT angiography. Interventional radiology other than angiographic procedures included needle biopsy, drainage, nonvascular stent placement, and therapeutic procedures. CT fluoroscopy and sonographically guided ablation were included with interventional radiology. MRI was defined to include research involving MRI, MR cholangiopancreatography, diffusion-weighted or perfusion MRI, cardiac MRI, MR spectroscopy, MR angiography, and functional MRI. Nuclear medicine studies included single-photon emission computed tomography and positron emission tomography. Sonography included all applications of diagnostic sonography, Doppler technique, and intraluminal endoscopic sonography. Conventional radiography included conventional tomography and studies in which contrast materials were used, such as barium studies, excretory urography, computed radiography, and fluoroscopy. A miscellaneous category included research that could not be classified by radiologic technique: articles about computers in radiology and molecular imaging as well as editor's notebooks. Articles about more than one radiologic technique were categorized according to the dominant technique used by the researchers. Research in which more than two techniques were used or in which the dominant technique could not be identified were grouped in the miscellaneous category.

Each article was also categorized by the country in which the corresponding author resided and in which most of the work was performed. Certain geopolitical changes of the past decade have caused the updating of geographic categories. For example, 13 articles originally categorized as being from Hong Kong have been recategorized as being from China. In addition, all publications were categorized as originating from one of seven geographic regions: North America, South America, Europe, Asia, the Middle East, Australia and New Zealand, or Africa.

Data for acceptance rates of all submissions during the most recent full 2-year period (January 2001–December 2002) were collected at the AJR editorial office. These acceptance rates were correlated with similar data collected from 1991–1992. Of the 3337 manuscripts submitted to the AJR from January 2001–December 2002, 584 were classified as letters to the editor or miscellaneous (photo pages, questions and answers, Medicine in American Art, or On the Viewbox) and were excluded from our analysis. The remaining 2753 submissions were used for our analysis of acceptance rates. The status of 25 of these submissions was still undecided when we closed data collection at the end of February 2003. Statistical analysis was performed using the contingency method.

Results

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The origin of articles published in the AJR was subdivided by country and geographic region, which are presented in Tables 1 and 2. A relative ranking of the top four countries in terms of publications in the AJR for each 3-year period is seen in Figure 1. The percentage of articles published in the AJR that originated from corresponding authors residing outside the United States was 10% (158/1610) in 1980–1982, 25% (441/1788) in 1990–1992, and 37% (602/1624) in 2000–2002 (p < 0.0001). Total articles from corresponding authors in the United States decreased from 1452 during 1980–1982, to 1347 during 1990–1992, and to 1022 during 2000–2002. During 2000–2002, Japan and South Korea contributed 11% of all published articles and 17% of the major papers. Also during 2000–2002, Austria, Belgium, China, Germany, South Korea, Switzerland, and Taiwan doubled the number of AJR articles that they had published during 1990–1992.

View larger version (23K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1. —Graph shows top four international contributors to AJR during each 3-year period. Data points on y-axis represent total numbers of AJR articles from that country. Flag size varies according to total number of articles.

In our analysis, we categorized the types of published articles as major papers, case reports, technical innovations, or editorials and reviews (Table 3). In 2000–2002, the number of major papers from international authors reached 45% of the total number of major papers published in the AJR. However, editorials and reviews were predominantly from authors in the United States; in fact, international authors contributed only 2% of the papers in this category.

Between 1990–1992 and 2000–2002, international articles describing research in humans grew in number and percentage for all subcategories defined by age: adults, pediatric patients, or mixed-age patients (Table 4). Experimental studies declined in number for both domestic and international authors.

Between 1980–1982 and 2000–2002, the number of international articles also increased when analyzed by organ system (Table 5). In 2000–2002, the number of international articles relating to cardiovascular (54% from international authors) and hepatobiliary (52% from international authors) systems surpassed those from authors in the United States. Articles from international authors relating to gastrointestinal (42%), neurologic (46%), and pulmonary and thoracic (48%) systems rivaled the articles from authors in the United States. In 2000–2002, the number of articles about musculoskeletal systems from international authors (65/203) constituted approximately one third of the total in this category; however, the percentage of musculoskeletal articles from international authors has doubled since 1990–1992 (34/201) and has increased sixfold since 1980–1982 [1].

Articles categorized by radiologic technique are presented in Table 6. Total articles during 2000–2002 related to angiography, nuclear medicine, sonography, and conventional radiography decreased by more than 50% when compared with 1990–1992. The number of articles from international authors about MRI more than doubled, constituting 49% of all AJR articles on the subject during 2000–2002 compared with 20% a decade earlier. Articles from international authors about sonography, nuclear medicine, and angiography declined significantly in number but increased in percentage of total articles.

Papers submitted by international authors remained less likely to be accepted than papers from corresponding authors in the United States (Fig. 2). During 2001–2002, the average acceptance rate was 33% (921/2753) for all types of manuscripts and all authors; however, for authors in the United States, the acceptance rate for all types of manuscripts was 44% (514/1169), whereas it was 26% (407/1584) for authors outside the United States. For 1991–1992, the acceptance rate of major papers was 33% for authors in the United States and 27% for international authors. For 2001–2002, the acceptance rate of major papers increased to 45% (294/655) for authors in the United States and to 31% (292/941) for international authors. The difference in acceptance rates was statistically significant (p < 0.0001). During 2001–2002, the acceptance rate for case reports and technical innovations was 32% (91/285) for authors in the United States and 14% (75/520) for international authors. When acceptance rates for all types of manuscripts were analyzed by country of origin, manuscripts from Switzerland and Austria were found to be most likely to be accepted (55% and 51%, respectively). Authors from the United States (44%), the United Kingdom (39%), Canada (35%), and Singapore (33%) also achieved higher acceptance rates than the average.

View larger version (13K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2. —Bar chart shows acceptance rates for authors in the United States (white bars) and international authors (black bars) who submitted three kinds of articles to AJR. Major papers include original reports (and, for 1991–1992, pictorial essays); case reports and technical innovations include radiologic–pathologic conferences; and editorials and reviews include perspectives, historical perspectives, editor's notebooks, reviews, centennial lectures, opinions, and commentaries.

Discussion

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International contributions to the AJR and other high-impact-factor journals in the United States have dramatically increased in recent decades. Özsunar et al. [4] found that international contributions to the AJR and Radiology reached 40% of all articles in 1999. In 2000, the AJR for the first time received more submissions from international authors than from authors residing in the United States [3]. Analysis of international contributions to the AJR during 1980–1982 and 1990–1992 found that the AJR was becoming more international [1]. Similar data collected for 2000–2002 coupled with the earlier data sets show that the trend toward internationalization has accelerated at the AJR. Although our data were collected for the AJR only, internationalization is likely to be a trend at all major radiology and other scientific journals published in the United States [4].

At the AJR, international authors contributed 10% of all original articles during 1980–1982 and 25% during 1990–1992. That figure increased to 37% during 2000–2002. Of course, many things may affect submissions to radiology journals. The introduction of new technologies such as CT angiography, MR angiography, and molecular imaging can have a major influence on the articles published by radiology journals [5]. One study found that 16.4% of all articles published in Radiology and the AJR involved new advanced technology [4]. Because new technology is expensive to acquire and maintain, authors at financially strong institutions have more opportunities to do research with state-of-the-art imaging equipment and then have their articles published.

Another piece to the submissions puzzle is the impact factor, which was introduced in the 1960s as a way to rate scientific journals worldwide [6]. The impact factor involves calculating the frequency of citation in the scientific literature divided by the total number of citable articles published by a specific journal in a 2-year period. The impact factor has become a major consideration for authors when choosing the journal to which a manuscript will be submitted. In general, articles published in English are easier to access and cite, so English-language journals have higher impact factors [6]. On balance, the higher the impact factor, the more desirable the journal. Journals in languages other than English rarely achieve high impact factors, putting them at a disadvantage for submissions. The AJR has maintained a high impact factor that is three to five times higher than the impact factors at regional radiology journals [7]. The result is that the AJR has more submissions to choose from and its acceptance rate is lower. Of course, many radiologists choose to submit manuscripts only to journals with high impact factors such as Radiology, the AJR, or other journals in the United States. When a manuscript is then published in a journal with a high impact factor, the researchers are likely to receive more academic credit than if the same manuscript were published in a national or regional scientific journal [6, 7]. In Europe and parts of Asia, administrators at medical schools use the impact factor as an objective measurement to rank faculty members for promotion and salary. Impact factors are even used to determine departmental budgets [7]. Such facts of academic life provide a primary basis for the increase in international submissions and articles at the AJR.

The total number of articles published in the AJR during the past three decades has remained stable. Submissions and publications from corresponding authors in the United States began decreasing in the 1990s as accompanying increases were seen from international authors. A major reason for the decreases from authors in the United States is the changing health care environment: academic radiologists have more clinical responsibilities and less time for research [2]. In particular, authors in Canada and France submitted fewer articles to the AJR as the 1990s wore on [2]. In Canada, a shortage of clinical income has caused the reduction of many fellowship programs in recent years. Academic fellows used to make major contributions to academic research. A strong fellowship program seems to be one key to encouraging and facilitating research and to producing junior faculty members who are keen to continue projects. We will not hypothesize on the major reasons for decreased submissions from France, Spain, and the United Kingdom [8] because their health care systems differ from the system in the United States.

In the past decade, many researchers have used more and more imaging techniques to make a diagnosis. For our analysis, such research presented difficulties of matching techniques to categories used in the past. Our decision to categorize multitechnique research as miscellaneous may seem unfair. Özsunar et al. [4] found that, during 1998–1999, the AJR and Radiology published more articles in which two or more imaging techniques were used than articles in which a single technique was used.

At the AJR, the number of articles from international authors has surpassed those from authors in the United States for cardiovascular (54%) and hepatobiliary (52%) research and are equal for the gastrointestinal and abdominal, neuroradiologic, and pulmonary and thoracic fields. In musculoskeletal research, AJR articles from international authors during 2000–2002 reached one third of the total articles on the subject compared with 5% during 1980–1982 and 17% during 1990–1992. However, during 2000–2002, articles about breast disease from international researchers lagged behind at 18%, the same level we found during 1990–1992 [1]. For most if not all organ system categories, international contributions are likely to dominate the AJR in another decade.

Although the acceptance rate of submissions from corresponding authors in the United States exceeded the acceptance rate for international authors, total submissions from international authors have surpassed total submissions from authors in the United States. Because this trend is likely to continue, international research may become dominant in the next decade. Indeed, at the AJR, in the not-too-distant future, publications from international authors are likely to surpass publications from authors in the United States.

References

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1. Elster AD, Chen MYM. The internationalization of the American Journal of Roentgenology: 1980–1992. AJR1994; 162:519 –522[Abstract/Free Full Text]
2. Rogers LF. Globalization: trends in the editorial content of the AJR. (editorial) AJR2001; 177:745[Free Full Text]
3. Jenkins C. Manuscripts submitted by corresponding authors residing outside the United States. AJR2001; 177:746[Free Full Text]
4. Özsunar Y, Unsal A, Akdilli A, Karaman C, Huisman TAGM, Sorensen AG. Technology and archives in radiology research: a sampling analysis of articles published in the AJR and Radiology.AJR 2001;177:1281 –1284[Abstract/Free Full Text]
5. Hillman BJ. The past 25 years in medical imaging research: a memoir. Radiology 2000;214 : 11–14[Abstract/Free Full Text]
6. Rogers LF. Impact factor: the numbers game. (editorial) AJR 2002;178:541 –542[Free Full Text]
7. Rogers LF. Internationalization of the AJR. (editorial) AJR 1999;173:1
8. Jenkins CB. Manuscripts submitted by corresponding authors residing outside the United States in 2002 and 2001. AJR2003 :181:906[Free Full Text]

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