A clinical image submission is a short article built around one or two diagnostic images, such as a photograph, radiograph, scan or histology slide, with a brief explanatory text. It works when the image itself teaches a recognisable finding. You need a sharp, labelled, de-identified image, written consent for publication, a few hundred words and few references.
Journals give the format different names: "clinical image", "images in medicine", "clinical picture" or "image quiz". Rules differ between titles, so this guide gives typical ranges. Before writing, confirm in the target journal's article types and author instructions that the format exists there.
Not every journal publishes image articles. At the time of writing, our own article types page does not describe a clinical image format or its limits, so this post is general guidance rather than a description of Directive requirements.
What a clinical image submission is, and how it differs from a case report
A clinical image article is a teaching item. Its job is to show one finding clearly and name it, so that a reader recognises it next time. A case report is a narrative. Its job is to describe a patient's course and explain why the case adds something, usually following the CARE guideline. If you need the longer format, writing a full case report with the CARE checklist walks through it.
| Feature | Clinical image article | Full case report |
|---|---|---|
| Core content | One or two images with a short explanatory text | Structured narrative: history, findings, timeline, treatment, outcome, discussion |
| Typical length | A few hundred words; some journals set a lower cap | A full manuscript of several pages |
| Abstract | Usually none | Usually required |
| References | A handful, sometimes none | A full list supporting the discussion |
| Authors | A small group; journals often cap the number | Set by authorship criteria and the journal's limit |
| Reporting guideline | No dedicated checklist; relevant CARE items still help | CARE checklist |
| Consent for publication | Written consent required | Written consent required |
The choice depends on what the case can support. If the lesson depends on a sequence of events, treatment decisions or follow-up, it needs a case report. If the lesson is visible in a single frame, the image format fits better and asks for far less writing.
What makes a clinical image publishable
Editors look for an image that makes its point without help. Ask three questions before you write a word.
- Is the finding visible without the text? A reader should see the abnormality before reading the legend. A subtle finding that needs a paragraph of explanation works poorly in this format.
- Does it teach something? A classic sign shown unusually clearly, a rare presentation of a familiar disease, or a finding that changed the diagnosis all qualify.
- Is the diagnosis secure? State how it was confirmed: histology, culture, further imaging or the clinical course. An image of a presumed diagnosis gives an editor little to accept.
Image quality, labelling and honest adjustment
Export the original at the highest quality your system allows. Submit it as a separate file rather than pasting it into the text document, which can reduce its quality. Resolution and file format rules are set by each journal, so check its instructions before you export.
- Crop to the region of interest, keeping enough anatomy for orientation.
- Mark the finding with arrows, arrowheads or asterisks, and explain every mark in the legend.
- Add a scale bar where size matters, and give the stain and original magnification for histology.
- Name the projection or plane for radiology, and the sequence for magnetic resonance imaging (MRI).
- Remove patient banners, dates and hospital names burned into the pixels.
Apply brightness and contrast changes to the whole image, and never add, remove or move a feature. Altering what an image shows is falsification, whatever the intention. The boundary is set out in where image adjustment ends and manipulation begins. Keep the unedited original file in case an editor asks to see it.
Consent and de-identification come before the text
A clinical image article needs the patient's written consent for publication, which is separate from consent to treatment. If the patient cannot give it, a parent, guardian, legal representative or next of kin signs, according to local law. The consent should name the specific images. Patient consent for case reports and clinical photographs provides an adaptable form and the statement to include.
De-identification is a separate task. Cropping removes what is visible, but the file can still carry the patient's name in its metadata. Digital Imaging and Communications in Medicine (DICOM) headers and phone photographs are the usual carriers. A black bar over the eyes does not anonymise a face. The file-by-file check is in de-identifying clinical images, DICOM exports and scans.
How long the text should be, and what it must do
The text of a clinical image article is typically a few hundred words, and some journals set a much lower limit. References are often limited to a handful, and some journals allow none. Author numbers are often capped at a small group, so list only people who meet the authorship criteria of the International Committee of Medical Journal Editors (ICMJE). These are typical ranges across journals, not a rule; the target journal's instructions decide.
Within that space, the text does four jobs. It sets the clinical scene in two or three sentences. It describes what the image shows. It names the diagnosis and how it was confirmed. It states the teaching point. Cut anything else.
A copyable template for the legend and text
The template uses lower-case slots for you to fill in. Delete any line the target journal does not ask for.
Title: [finding] in [condition or setting]
Authors: [name, degree], [affiliation], [orcid id] — repeat for each author, within the journal's limit
Figure legend: ([panel letter]) [image type, view or sequence, stain and magnification] showing [finding] ([arrow or marker]). ([panel letter]) [second image] showing [finding].
Text: A [age band] [sex] presented with [symptom] for [duration]. [relevant history in one sentence]. [examination or imaging finding, referring to the panel]. [how the diagnosis was confirmed]. The diagnosis was [diagnosis]. [one sentence on outcome, if relevant]. [teaching point: what a reader should recognise next time, and why it matters].
Consent statement: Written informed consent was obtained from [the patient or their representative] for publication of this article and the accompanying images.
Declarations: [conflicts of interest]; [funding]; [author contributions]
References: [reference 1]; [reference 2] — within the journal's limit
The filled example below is invented to illustrate the structure. It describes no real patient, and the author details are placeholders.
Title: Target lesions on the palms in erythema multiforme
Authors: [name, degree], [affiliation], 0000-0002-1825-0097
Figure legend: (A) Clinical photograph of the right palm, cropped to the hand, showing round lesions with three concentric zones (arrows). (B) Skin biopsy, haematoxylin and eosin stain, original magnification ×200, showing interface change with scattered necrotic keratinocytes (arrowhead).
Text: A man in his thirties presented with a burning rash on both palms, a week after a cold sore on his lip. Examination showed round lesions with a dark centre, a pale ring and a red outer ring (panel A). A skin biopsy was consistent with the clinical diagnosis (panel B). The diagnosis was erythema multiforme associated with herpes simplex infection. The rash resolved during follow-up. Recognising the three-zone pattern helps separate erythema multiforme from other rashes with target-like lesions.
Consent statement: Written informed consent was obtained from the patient for publication of this article and the accompanying images.
The age band and the tight crop both reduce what a reader could use to recognise the patient.
Pre-submission checklist for a clinical image article
| Check | Done when |
|---|---|
| The journal publishes this format | You have found it among the journal's article types and read its limits |
| The image teaches one clear point | A colleague can name the finding before reading the text |
| The diagnosis is confirmed | The text states how it was confirmed |
| Image files are separate and at full quality | Files meet the journal's stated format and resolution |
| Every marker is explained | Each arrow, asterisk and scale bar appears in the legend |
| Adjustments are whole-image only | No feature added, removed or moved; the original file is kept |
| The pixels are clean | No names, dates, hospital or record numbers are visible |
| File metadata is stripped | Checked on the exported file, not the original |
| Written consent for publication is held | It names these images, and the statement is in the text |
| Word, reference and author limits are met | Counted against the journal's instructions |
| Declarations are complete | Conflicts, funding and contributions are stated |
| No parallel submission | The same image is not under review at another journal |
The wider package around the article, including author details, declarations and approvals, is listed in the journal submission checklist. If you spot an error in this guide or in anything we have published, here is how to report a problem to us.