Expert-validated criteria for evaluating 2D anatomical images: Results of a Delphi consensus study

Currently, there are no consensus standards for the selection of two-dimensional (2D) anatomical images that form the basis of anatomy education. The absence of standardized evaluation criteria may contribute to variability in image quality and inconsistencies in the educational use of anatomical visuals, potentially affecting students' development of an accurate understanding of anatomy. Addressing this gap is important for supporting the reliable and educationally effective use of 2D anatomical images in undergraduate medical education. An initial pool of 70 candidate criteria was generated through literature review and expert input and organized into seven domains. A modified two-round Delphi process was conducted. In Round 1 (n = 20), experts rated each criterion on a five-point scale. Domain-specific cut-off values were applied, and the item-level content validity index (I-CVI) was calculated. In Round 2 (n = 15), experts reviewed domain appropriateness and item wording. Thirty-four criteria met predefined thresholds and were retained. The scale-level content validity index was high (S-CVI/Ave = 0.94). In Round 2, mean agreement on domain appropriateness was 97.8%, and 90.2% of items were retained without modification. Modified kappa analysis demonstrated excellent agreement beyond chance (mean k* = 0.93). No new criteria were proposed. This study developed a 34-item, expert-validated checklist for evaluating static 2D anatomical images. The high consensus levels support its potential utility in improving the quality, consistency, and educational relevance of visual materials used in anatomy education.