Top 50 AJR papers highlight radiology's staying power

Many of the most frequently cited radiology articles of the Cold War era remain relevant today, according to a study in the September issue of the American Journal of Roentgenology.

Nearly 20 years ago, Dr. Felix S. Chew compiled a list of the 50 most often cited AJR articles published between 1945 and 1987 (AJR 1988;150[2]:227-233). Dr. Liem Bui-Mansfield recently revisited the list to see how those articles stand up today. He found that nearly half have risen in ranking.

"Radiologists should keep track of this list because it reflects our history, the history of medicine, and it helps us understand and appreciate radiology," said Bui-Mansfield, a radiologist at Brooke Army Medical Center in San Antonio.

The updated ranking reflects medicine's move toward minimally invasive diagnostic and therapeutic procedures. In addition, several articles at the top of the list mirror the current level of public awareness about medical, environmental, and social issues, including brain and breast cancer, cardiovascular disease, radiation exposure, and child and spousal abuse.

"The list illustrates the evolution of radiology as well as medicine. It shows that many papers that are frequently cited to this day deal with problems that remain a daily concern to patients, referring physicians, and radiologists," he said.

The original article included the 50 most-cited AJR papers published between 1945 and 1987. Bui-Mansfield ran the same list through the Institute for Scientific Information's Web of Science search engine, a privately owned abstract research database that could effectively handle the span of years. The articles were ranked based on the number of citations in scientific journals published between 1945 and 2004. Three articles did not change their position in the ranking since 1987:

- "Observations on growth rates of human tumors," Collins et al, 1956 (number 1 in both polls);

- "Clinical NMR imaging of the brain: 140 cases," Bydder et al, 1982 (number 2); and

- "Percutaneous catheter drainage of abdominal abscesses guided by ultrasound and CT," Gerzof et al, 1979 (number 22).

Twenty-three articles have risen in ranking since 1988. Articles with the largest increase in ranking were:

- "Breast patterns as an index of risk for developing breast cancer," Wolfe et al, 1976, moved from number 39 to 5;

- "Diagnosis of abdominal malignancy by radiologic fine-needle aspiration biopsy," Ferrucci et al, 1980, went from number 50 to 18; and

- "The vertebral vein system-Caldwell Lecture," Batson, 1957, rose from number 46 to 20.

Bui-Mansfield found that the articles at the top of the list presented clinically relevant topics appealing to a broader medical audience beyond radiology. Pathologists, oncologists, and surgeons, as well as radiologists, would tend, for example, to cite Collins' "Observations on growth rates of human tumors" in subsequent studies. The same is true for breast cancer screening and treatment, which have become important public health issues. Research conducted by primary-care physicians, surgeons, and radiologists frequently cited Wolfe's 1976 paper, according to Bui-Mansfield.

Conversely, the decrease in ranking of some articles is attributable to the rapid advance of technology. "Prolactin-secreting pituitary microadenomas: roentgenologic diagnosis," by Vezina et al (1976) had the sharpest drop in ranking, from 9 to 34, because MRI is now the imaging technique of choice for the diagnosis of pituitary masses.

Papers on clinical applications and new techniques in imaging account for most (82%) of the titles on the list. More than half involve the subspecialties of interventional radiology, radiation oncology, and abdominal imaging. Almost two-thirds of the articles address 13 common clinical problems, including Hodgkin's disease, gallbladder disease, nonaccidental trauma, and lung cancer.

The ranking also reflects radiology's positive impact on healthcare through more accurate, safer diagnostic procedures and the development of image-guided, minimally invasive therapies. Radiologists, however, still fight an uphill battle for acknowledgment.

"Despite radiologists' significant contribution to medicine, patients tend to recognize surgeons and other physicians much more than radiologists for their well-being," Bui-Mansfield said. "This list should help raise awareness of radiologists' role in medicine."

imaging specialties - health policy and practice

medical specialties - radiology

modality - health services

Current topics of most frequently cited papers

(in descending order)

1. Tumor growth (1956*)

2. Brain pathology (1982)

3. Nonaccidental trauma (1946)

4. Vascular occlusion (1975)

5. Breast cancer (1976)

6. Radiation effects (1965)

7. Medulloblastoma (1969)

8. Angiography (1939)

9. Hodgkin's disease (1950)

10. Contrast reaction (1975)

*Year of publication