White Horse, Yellow Journal: Berquist Bids Adieu to AJR

Logan Young
Staff writer

When Thomas H. Berquist logs off his iPad this summer, his 12-year tenure as the 12th editor in chief of the American Journal of Roentgenology (AJR) will capstone a period of unprecedented growth for the 113-year-old publication. Truly the end of an era, only two other men will have occupied the AJR’s chief chair longer than Berquist: Lawrence Reynolds, who picked up the mantle in 1930 and died in office 31 years later, and his immediate successor, Traian Leucutia, whose editorship (1961–75) lasted just two years longer than this lauded, yet humble Mayo Clinic radiologist.

Articulating an expansive vision for radiology’s beloved “yellow journal” from his first days at the desk in late 2008, the ARRS Publications Committee, to whom Berquist has reported for some 150 issues of AJR, agrees that he’s fostered a unique editorial climate ever since—one of both exacting rigor and earnest diversity.

“Dr. Berquist is one of the most inclusive leaders that I have ever had the pleasure to work with,” says Deborah Baumgarten, ARRS Publications Committee chair. “He solicits opinions and really listens to and considers what others have said. You feel like you matter to him.”

Acknowledging achievement only if it’s data-borne, the internationally recognized author of 38 books on medical imaging tells InPractice he remains very much “a numbers guy.”

Incidentally, despite ARRS’ announcement of Berquist’s retirement more than 15 months ago, submissions to the journal continue to pour in unabated. And although AJR’s acceptance rate “still hovers right around 20%,” Berquist does admit that the overall quality of the articles being submitted is likely as good as it has ever been.

For once, there’s a causation implied by the correlation.

Two years ago, Berquist himself took to these same pages to reassert AJR’s raison d’être in two words: “evidence-based articles." Codifying the journal’s reporting guidelines for Original Research and Review articles “to assist authors in providing optimal consistent content,” he also detailed significant revisions to the Standards for Reporting Diagnostic Accuracy Studies (STARD) and Standards for Reporting Observation Studies in Epidemiology (STROBE) checklists, “in an effort to provide more imaging-friendly guidelines.”

With humility and precision, Berquist now notes, “to date, there have been 128 STARD submissions and 33 STROBE submissions to AJR,” casually mentioning the “significant recruitment initiative” he’s spearheading to further improve these types of content enhancement, which he’s keen to note will soldier on even without him aboard.

Circulation is up, too. With AJR enjoying record readership worldwide—especially unique views and clicks, online and mobile, at AJRonline.org—as the outgoing editor in chief wrote in his “Things We Learned Along the Way” editorial from November, “the online version is the journal of record."

It was Berquist’s predecessor, Robert Stanley, who introduced the notion of electronic article submission. Not surprisingly, his institution of web-based submissions yielded a marked increase in international authors submitting to AJR, sending Stanley and staff scrambling to enlist foreign-language reviewers. Sixteen years post-Stanley, Berquist recalls yet another telling audit.

“Currently, there are 2,321 total AJR reviewers,” he says. “Eighty percent hail from the United States, and 20% are based internationally.”

Asked how a more international distribution due to ever-increasing scholar globalization might alter the scope of AJR content to come, thus far, Berquist says he’s seen only one year, 2014, where foreign submissions outpaced submissions from the U.S. As always, Berquist’s bias tends toward scientific scrutiny, not identity politics, “particularly where a benign cultural difference could escalate to the level of significant medicolegal dilemma.”

Ultimately, he’d much rather talk residents and reviewers than matters foreign and domestic. Regarding residents, Berquist is quick to credit Howard P. Forman for initiating the journal’s Trainee Reviewer program, pointing out the present group of “61 trainee reviewers and additional new reviewers who have mentors as they begin their reviewer role.”

Naturally, Berquist has streamlined the onboarding process; it began two years ago at the Marriott Wardman Park Hotel in Washington, D.C.

In 2018, alongside Cheryl S. Merrill, ARRS’ director of publications, Berquist debuted what would eventually become an essential component of the ARRS Annual Meeting that speaks volumes about the significance of scientific integrity—a two-hour course the duo affectionately dubbed “Rock the Review: How to Get a Perfect Score.” A perfect score equals 4.0, sure, but what does said “rocking it” actually look like on the page?

For that inquiry, Berquist settles in: “The review must include sophisticated, detailed comments to authors with line and page referencing to enhance the content and relevance of the work; concise, confidential comments to the editor; and the reviews must be completed in the allotted 14 days or earlier.”

As for his active reviewers, again, Berquist knows their numbers by heart.

“Ten percent of AJR reviewers have scores less than 3.0, and 40% have scores between 3.0–3.5,” he says. “Half of the reviewers for AJR, nearly 1,200, have a perfect 4.0,” Berquist half-beams, adding that each and every reviewer is evaluated at least yearly, “more frequently should their approach warrant it.” He reveals “any reviewer may request a review of themselves at any time,” too.

Resigned to the inherent difficulty of “consistent communication” with more than 2,300 reviewers across the globe, Berquist’s not bereft of procedure here either.

“There are multiple data points available each day,” he says of his quality control, “including how many invitations a reviewer has received, accepted, and declined; how many times a reviewer has been uninvited for not responding; the last review accepted and completed and the last review declined; reviews in progress; and the mean reviewer score.”

Lest you think he’s all scores and no play, there are prizes—albeit hard-won ones.

Known for penning personal letters to stellar reviewers, Berquist also established “a Distinguished Reviewers category for individuals performing 10 or more reviews in a given year with scores of 3.0 or higher.” Reviewers’ names are featured on the AJR masthead for the entirety of the following year, and their departmental chairs are notified of the distinction.

For “above and beyond assistance,” states Berquist, “we initiated the Gold and Silver Distinguished Reviewer Achievement Awards in 2018 for reviewers with 100 or more reviews and 50–99 reviews, respectively.” These reviews must be scored at least 3.5, and Berquist remarks that 91 AJR reviewers have received 14 gold and 77 silver trophies during the Reviewer’s Luncheon at the ARRS Annual Meeting.

“We now have Platinum and Diamond Distinguished Reviewer Achievement Awards for scores 3.5 or higher for 150–199 reviews and 200 or more reviews, respectively,” he says with that muted smile returning.

Acknowledging that the whole notion of peer review itself is in flux, Berquist’s not averse to the creep of new ideas. His interest in zeitgeist systems thinking, like Just Culture, has been abiding, and he confesses to “a certain anticipation” for an updated model of shared accountability.

Never not teaching, the diagnostic radiologist is wont for a metaphor.

“Peer review is a lot like the Supreme Court,” Berquist claims. “It’s by no means perfect, but it’s the best we have now.”

For all reviewers, authors, and journal staff, time is always of the essence. Recalling an AJR authors’ survey “where 85% of respondents considered speed to publication extremely important,” once more, the numbers stay on Berquist’s side.

“In 2013, the time to first decision was 37.6 days,” he says. Streamlined protocols in 2017, implemented by the journal’s in-house staff, shrunk that time down to 25 days. For 2019, Berquist tallies “the average time to first decision is 18.8 days,” compared to 20 days at the same time the previous year.

Prior to recent concerted efforts, he laments that the elapsed time from first decision to AJR publication measured a “protracted 147 days.” Understandably, Berquist happily reports that number has been cut almost in half.

Asked who or what is most responsible for this optimized circle to publication, AJR’s chief editorial officer neither hesitates nor equivocates: “The journal staff deserve the credit—all of it.”

Berquist balks at the term officer. His self-effacing streak matched only by his work ethic, this self-described “policeman with no gun” has doggedly pursued often competing commitments at AJR—everything from article enhancements, reviewer recognition, and production improvements to that ever-important journal impact factor.

And at least until June, armed or not, the buck still stops with Berquist.

AJR Podcasts

AJR Podcasts feature authors of select AJR articles discussing how they performed their studies and how the results changed their practices.

“Right now, the impact score of AJR is 3.161,” he rattles off to the third decimal. “That’s the highest the score has ever been. But it’s not yet a 4, so in that regard,” he doesn’t pause, “I’ve failed.”

Impact factor is a scientometric index, yes, but Berquist concedes there are more popular proxies, especially in pixels. It was under his administration that ARRS joined Twitter, posted a DOI on Instagram, and published an AJR video to YouTube. It was during Berquist’s watch that democratized platforms such as these breathed new, sometimes second lives to articles about magnetic eyelashes as MRI artifacts and his personal favorite, radiologic detection of inadvertently ingested wire bristles from a grill-cleaning brush.

“It’s exciting, it’s all visibility, and we’re getting much better at it,” Berquist says of social media exposure. “We’re also exploring more and more things adjacent to it,” his subtle reference to AJR Podcasts, available cross-platform via iTunes and Google Play.

At the end of the day, it’s not impact factor or Just Culture or homepage views that’s kept Berquist up at night these last 12 years.

“For me, the key thing has always been scientific integrity,” he says. “In fact, it’s really only this. But in reality, there are times when I feel alone on this white horse, swinging at windmills.”

Of course, the man of La Mancha never had to traverse this modern landscape of so many open-access journals—an “exponential proliferation” our Jacksonville, Florida physician cites as his chief concern for medical publishing moving forward.

“There were about 80 radiology journals when I began at AJR,” Berquist remembers. Today, he inventories more than 800 open-access journals publishing medical imaging content on a regular basis. How could Berquist alone possibly guard against every duplicative breach?

“I’m not sure we can anymore,” Berquist answers, invoking both pronouns.

According to the editor in chief, AJR uses a huge database, Similarity Check (CrossRef), for manuscript evaluation, as well as “a 10% or greater duplication and singles source greater than or equal to 3% to help assess duplication more thoroughly.” Given that a typical year will end in more than 1,800 submissions to the cue, the journal’s two-factor safeguard invariably yields “a staggering number” of replicate queries.

Noting that medical schools, residency programs, and fellowships lack a proper course in publishing ethics—Berquist’s biggest regret is not advocating harder for a nationwide curriculum—“only 1.8% of the submissions AJR receives contain less than 10% duplication,” he sighs. “We can’t keep kicking this can down the road.”

With nuclear medicine becoming de rigueur in the 1960s, ARRS members of a certain vintage will recall how Traian Leucutia relented to rechristening AJR the American Journal of Roentgenology, Radium Therapy, and Nuclear Medicine. The late Melvin M. Figley not only changed it back in 1976, he kept the word “Roentgenology” in the title, maintaining its myriad historical associations. As radiology enters the third decade of the new millennium, does Berquist see an emerging modality or pressing topic that could necessitate another retitling of the journal?

“Believe it or not, changing the name of AJR has come up,” he says. “Imaging, as a whole, is a lot of different things, and imaging is always evolving, so if the ABR’s requirements change accordingly, I could foresee the ARRS Executive Council maybe taking a vote.”

Berquist has but one simple request for the next editor: “Whatever happens, I just hope we’ll keep on calling AJR the yellow journal.” Having championed the leading resource for practicing physicians and allied health professionals engaged in patient-centered medical imaging, let no one dare call what he’s done “yellow journalism,” though.

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.