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Evidence levels in radiology: the insights into imaging approach

Medicine is based on knowledge from scientific studies and the validation of clinical experience. Medical knowledge must be well established before it can be considered as the basis for decision making. Journals have a clear responsibility to help readers recognize the level of evidence for the claims published in their manuscripts. Levels of evidence alone do not determine the quality of the article but help readers to understand the significance of the claims.

We recognize that our discipline, radiology and medical imaging, also suffers from a certain lack of reproducibility of its results when translated into practice. Although our clinical work is firmly based on years of practice and well-known criteria and characteristics, new proposals and some older standards are not free of errors and biases.

This is the main reason why our journal encourages authors to follow this guideline when analyzing referenced papers and their own work (Table 1). The level and confidence in the evidence and the degree of consideration of the recommendations and their wordings are based on the type and quality of the references and the results of the paper. Authors are encouraged to specify in the manuscript the appropriate level and recommendation of their claims, following the criteria of this journal. The categorization into only three levels is based on publications in addition to critical approach to technical and clinical studies related to medical imaging [1,2,3,4,5]. These levels attempt to reconcile scientific knowledge and clinical certainty. We hope that this classification and grading will enlighten readers to better understand the relevance of published results and claims.

Table 1 Levels of evidence and recommendation

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All relevant data are published in this Editorial.


  1. 1.

    Guyatt GH, Oxman AD, Vist GE et al (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336:924–926

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    Schweitzer ME (2016) Evidence level. J Magn Reson Imaging 43:543–543

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  3. 3.

    Evidence-Based Radiology Working Group (2001) Evidence-based Radiology: a new approach to the practice of radiology. Radiology 220:566–575

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  4. 4.

    European Association for the Study of the Liver (2018) EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 69:182–236

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    Fryback DG, Thornbury JR (1991) The efficacy of diagnostic imaging. Med Decis Making 11:88–94

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This paper was written and revised by LMB. The author read and approved the final manuscript.

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Correspondence to Luis Martí-Bonmatí.

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Luis Martí-Bonmatí is the Editor-in-Chief of Insights into Imaging. For this reason, he was not involved in any way in the revision/decision process, which was completely managed by the Deputy Editor, Prof. Bela Purohit (Singapore/SG).

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Martí-Bonmatí, L. Evidence levels in radiology: the insights into imaging approach. Insights Imaging 12, 45 (2021).

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