1 Why Is it Important to Add Illustrations to your Manuscript?

Adding illustrations to a research paper makes the manuscript more readable and attractive. As compared to text-only adding visual aids like radiological images (X-rays, ultrasounds, CT, PET or MRI scans), pathological material (gross tissues, cytopathology, histopathology) using new medical tools or kits which support your diagnosis improves the comprehension and recall for the reader [1]. Illustration is also an effective way of communication both for the doctor and also for the patient [2].

figure a

2 How Do Illustrations Help in Teaching?

Illustrations help in teaching students the subjects of anatomy, physiology, general surgery, pathology, radiology and neurosurgery [3]. For cardiology also learning through photos of echocardiography, angiography and endoultrasound helps in learning [4]. A doctor who is an artist also understands what needs to be shown in an illustration. The grasping power of the student also increases tremendously. Medical students depend a lot on illustrations to learn anatomical facts and supplement the knowledge given in their textbooks. Often, an illustration transmits pertinent fact or useful information much more successfully than words. They ‘tell a story’ through their drawings. For surgical disciplines especially learning through illustrations aids surgical technique. Thus, the use of illustrations is an integral aspect of teaching, learning, and communication.

3 What Medium Can be Used for Representation of Art in Medicine?

The commonest is the use of clinical or radiological photographs which are easy to capture using smartphones. They are handy and the illustrations are quite clear. Histopathological slides require special techniques to take images. A line diagram can be drawn with the help of a pencil or fibre tip black pen. For making posters, one can use poster colours or coloured pens. Nowadays creating digital illustrations are also possible. They are fast, easy to edit, and take less time. Newer digital tools like the Apple iPad, laptop, or Mac Pro can be also useful. Adobe illustrator and photoshop help to edit illustrations [5].

4 Can Illustrations be Submitted to Journals for Publication?

Many leading journals like the BMJ and NEJM accept images as a separate type of publication under the heading ‘Images in Medicine’ or ‘image quiz’. However, the images should have the following qualities—they should be:

  • Clear.

  • Rare.

  • Sharp.

  • Uniquely educative.

  • Having a good reproduction.

The image can be submitted either as a PowerPoint presentation or saved in the TIFF, JPEG, or EPS formats. The accompanying text should be saved as a Word document about 150–200 words long. This usually allows a maximum of two authors and not more than five references. No abstract is usually required.

5 What Are the Ten Important Unsaid Rules for Adding Illustrations to your Manuscript?

The important key ten points for adding images for the biomedical manuscript are given below [5, 6].

  1. 1.

    Add a picture that enhances the knowledge in the paper. Always cover the eyes. Many journals will ask for extra consent from patients if you are showing a clinical photograph. Figure 23.1 shows a 3D printed face mask.

  2. 2.

    Crop the image and, remove the date, name and all personal information from the photograph. The chest-X-ray on the left looks much better after cropping. However, do not crop so much that the pathology becomes unclear and one cannot make out which organ is being shown as shown in Fig. 23.2.

  3. 3.

    Add legends to illustrations. A Description or a Caption about the picture should always be included, otherwise one cannot focus upon what needs to be highlighted (Figs. 23.3 and 23.4) [1].

  4. 4.

    Avoid using abbreviations in the legend to the illustration.

  5. 5.

    Allot serial numbers to all figures and add a description of the photo in the text [6, 7].

  6. 6.

    Use arrows to show what you are highlighting. Figure 23.5 shows a muscle biopsy in patient with dermatomyositis.

  7. 7.

    You may show pictures before and after therapy to depict the improvement after treatment. Figure 23.6a and 23.6b depicts a pneumothorax in a patient with AIDS before and after treatment.

  8. 8.

    Make separate files for photographs in jpg or JPEG formats for submission.

  9. 9.

    Read the instructions to authors before preparing your manuscript regarding how many illustrations you are allowed to include.

  10. 10.

    Use cartoons or hand diagrams to supplement the understanding of the pathology.

  11. 11.
    figure b
Fig. 23.1
figure 1

New 3D printed design of a face shield to protect from COVID-19

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Fig. 23.2
figure 2

Chest X-ray revealing right-sided lower zone opacity with fluid in the fissure

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Fig. 23.3
figure 3

Depicts Staphylococcal dactylitis in a diabetic patient

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Fig. 23.4
figure 4

Multiple calcified lymph nodes in a patient with Sarcoidosis

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Fig. 23.5
figure 5

Arrow points to perivascular infiltrates in a patient with Dermatomyositis

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Fig. 23.6a
figure 6

Shows arrows pointing to the collapsed lung in a pneumonia

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Fig. 23.6b
figure 7

The lung collapse has improved after chest tube insertion

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6 Conclusions

  • When words alone are not enough, an image may be needed to explain a scientific process or promote clarity.

  • Medical illustrations can help to demonstrate surgical techniques and simplify the burden of a complicated text.

  • A good illustration helps to tell a story. Images are effective tools in medical education.