How to Prepare Clinical Images for a Case Report

Clinical images can make a case report much more useful, but each one must be consented, de-identified, accurate, properly labelled and technically suitable for the journal. Never alter an image in a way that changes its content.

Before taking or using an image

• Confirm consent that specifically covers images and their publication.
• Check institutional policy for taking and storing clinical images; use approved systems, not personal phones, unless policy allows.
• Decide what the image needs to show.

De-identification

• Remove names, dates, hospital numbers and metadata from images and files (for example DICOM headers or EXIF data).
• Crop faces, tattoos and distinctive features unless essential and consented to.
• Cover or remove identifying text in screenshots and scans.

Quality and labelling

• Use the resolution and formats the journal requires.
• Include a scale or reference where size matters.
• Label arrows, letters or panels clearly, and explain them in the caption.
• Write captions that stand alone: what is shown, view or sequence, and why it matters.

Integrity

Adjustments such as brightness or contrast must be applied to the whole image and not alter or hide information. Do not add, remove or move features. Journals may check images for manipulation and consider inappropriate editing a research integrity matter.

Illustrative example

Invented for teaching. A CT scan screenshot shows a patient identifier. The author crops it, saves the cropped image in the required format, and writes the caption: "Axial contrast-enhanced CT showing a 3 cm mass (arrow) in the left kidney."

Common pitfalls

• Leaving metadata or name labels in images.
• Over-editing contrast so that findings are exaggerated.
• Using an image from another source without permission.

Key takeaways

• Consent, de-identification, quality and integrity.
• Follow the journal's technical instructions.

This page is general educational information about research methods. It is not medical, legal or regulatory advice; follow your institution's ethics board and your target journal's instructions.