The IMAGE Statement: A Proposed Reporting Guideline for Clinical Images-A CARE Guideline Extension

Clinical image publications represent an important educational resource across healthcare disciplines, providing concise visual demonstrations of diseases, diagnostic findings, and therapeutic outcomes. Despite their widespread use, reporting practices remain highly heterogeneous, with substantial variability in the description of clinical context, image acquisition, ethical considerations, and educational content. Existing reporting guidelines, including the CARE Guidelines, do not specifically address the unique methodological and technical aspects of image-based publications. The aim of this study was to develop the IMAGE Statement (Improving Clinical Image Reporting Standards), a reporting guideline specifically designed for clinical image publications as an extension of the CARE Guidelines. The development process was informed by recommendations from the EQUATOR Network and included a literature review, analysis of journal instructions for authors, generation of candidate reporting items, and expert consensus. The resulting IMAGE Statement comprises 15 essential reporting items covering the title, patient information, clinical context, diagnostic assessment, image acquisition, image quality, image selection, image annotation, image description, diagnostic interpretation, final diagnosis, educational message, ethics and consent, artificial intelligence use disclosure, and figure legend. The IMAGE Statement provides a structured framework intended to improve completeness, transparency, reproducibility, educational value, and ethical reporting of clinical image publications across healthcare disciplines.