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rstanley{at}uabmc.edu
Well, here we are in the beginning of our third year of being Web based. The changes involved with being Web based affect my duties as editor in chief daily. Since July 2006, we have been adding 100 pages of text to our journal, exclusively in the online version of the monthly issues. This will greatly help us reduce the size of the lengthy pipeline of accepted manuscripts and keeps our 100-year-old journal in pace with the times! We do recognize that this change—to online only— may mean a little adjustment for some of our authors who would prefer to see their articles in the print version of the journal, but Web exclusive publishing offers a number of advantages over just print publishing:
Furthermore, the official version of our journal is the online version. It has been that way for several years. We recognize that some of our readership still do not readily access the Internet for their educational pursuits. However, the percentage is unquestionably decreasing with each passing year. There are certain types of manuscripts that more than likely would appeal to and be readily accessed by those who frequent their desktop or laptop computer. These include articles in the Computer/Informatics in Radiology section, Radiological Physics section, and some Technical Innovations. We also have elected to include most of the remaining case reports and AJR Viewbox manuscripts (neither manuscript types are now accepted for submission to the AJR). The task of selecting major content manuscripts for Web exclusive status is my responsibility and that of the senior staff in the AJR production office.
We select Web exclusive candidates in a fair and consistent way from all of the different manuscript types that are submitted to us. Thus, one can find Original Research, Clinical Observations, Pictorial Essays, Perspectives, Reviews, and Commentaries distributed throughout the Web exclusive section in approximately the same percentage as they appear in the print version of the journal. Those selected are not "children of a lesser god" but rather, in our opinion, readily lend themselves to display in an online format for special reasons, for example, do they feature 3D art, are there cine films, are there complex tables? The Web exclusive articles undergo the same rigorous peer review and acceptance process as the print-only articles and are equal in status to the manuscripts in the print version. The real challenge is to get a manuscript accepted; we have recently raised this bar very high.
The day I drafted this Editor's Notebook was my birthday. While I will not go into details, I would say that the word "senior" comes to mind. On reflecting back, I have certainly learned that change and the need to adapt to it is an ongoing part of living. Like my predecessor, Dr. Lee Rogers, I began my training in radiology in the days when dark adaptation with red goggles was required prior to doing fluoroscopy. So, both he and I have been able to experience all of the new and wonderful imaging methods that have since appeared on the scene. My colleagues and I at the Mallinckrodt Institute of Radiology were able to evaluate one of the first two EMI body CT scanners in the mid-1970s. We and other members of the fledgling Society of Computed Body Tomography (now the SCBT&MR) had the temerity to publish an article on the appropriate indications for extra-cranial body CT [1]. Because this powerful imaging tool was still in its infancy, this list of indications was needed. Certificate of need agencies throughout the country were questioning the need for the acquisition of CT scanners in many hospitals. Early on, it was viewed as a new technology out of control. Experience over the years has proven otherwise.
In 1993, the American College of Radiology created the Task Force on Appropriateness Criteria to clarify the use of diagnostic imaging methods in various disease states. In 2000, the Task Force became the Committee on Appropriateness Criteria under the ACR's Commission on Quality and Safety. These criteria are now updated online and are widely available for use [2]. Their purpose is to improve radiologic decision-making based on scientific analysis and broad-based consensus technique, hopefully leading to more cost-effective practice.
In this issue, a most interesting article by Levy et al., reports on the use of the ACR appropriateness criteria by a preauthorization center for MRI requests located in Tel Aviv, Israel [3]. While the number of requests did not change after the center started using the appropriateness criteria, their introduction resulted in an increase in the rate of performance of appropriate MRI examinations and a decrease in the rate of inappropriate MRIs. The result was most desirable and is exactly what the ACR hopes to achieve with them. As a former member of the Board of Chancellors of the ACR, it is gratifying to see that the efforts of the College can have a global impact. I recommend this timely and thought-provoking article involving the practice of radiology to you.
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