More than a rebuttal: a field guide to letters to the editor in radiology.

Letters to the Editor (LTEs) provide an important platform for academic communication. They enable researchers to engage with recently published studies, share their opinions, and contribute to the ongoing discussions in their fields. While traditionally viewed as rebuttal-type responses to target articles, LTEs can be written in more flexible formats, including matchmaking-type, agreement/praise-type, building-upon-type, independent-type, and case report-type LTEs. These variations allow for discussions that range from methodological critiques to new insights, interdisciplinary perspectives, or important clinical experiences. Unlike the text-based critiques common in other fields, LTEs in radiology often involve discussion of visual data or technical performance measures. Further, engaging with sociological issues such as the ethical considerations of radiation exposure or contrast agent use can help improve clinical judgment, not only for researchers but also for radiologists in daily practice. This review article introduces and classifies multiple types of LTEs based on examples of LTEs in journals related to radiology. Practical guidance is provided on how to select appropriate topics, structure arguments, and adhere to journal-specific submission guidelines. We also outline the publication process from submission to potential reply by the original authors. Writing LTEs has several benefits: it encourages critical thinking, improves scientific writing skills, and promotes participation in academic communication. Furthermore, LTEs contribute to the transparency in peer-reviewed literature and may inspire future research. When written respectfully and constructively, LTEs serve as a high-level tool for academic communication and scientific development. This review aims to make LTEs more accessible and practical for researchers, particularly in the field of radiology, by demonstrating their flexible formats and academic value.