In the professional spheres of medical publishing and technical communication, "AMA pictures"—formally referred to as figures—must adhere to the rigorous standards established by the American Medical Association. This guide outlines the essential requirements for image resolution, ethical de-identification, copyright compliance, and the integration of emerging technologies like AI-generated visualizations in 2026.
Understanding AMA Style for Visual Elements
In the context of the American Medical Association (AMA) Manual of Style, the term "pictures" is broadly categorized under Figures. This classification includes a wide variety of visual material, such as photographs, line drawings, graphs, maps, and radiographic images (X-rays, CT scans, and MRIs). The primary purpose of an AMA-compliant figure is to augment the reader's understanding of complex data or clinical observations that cannot be adequately described in text alone.
As of 2026, the transition toward digital-first publishing has placed a higher premium on metadata and accessibility. Figures are no longer static "pictures" pasted into a document; they are data-rich assets that must be searchable, accessible to those with visual impairments, and high-quality enough for both high-resolution displays and traditional print.
The distinction between a "table" and a "figure" is fundamental. Tables are used for the algebraic representation of data in rows and columns, while figures are used for the geometric or visual representation of information. If a visual element contains primarily text or numerical data arranged in a grid, it should be treated as a table. If it relies on spatial orientation, color, or imagery, it is an AMA figure.
Technical Specifications for Image Submission
Achieving professional quality in medical and scientific imaging requires strict adherence to technical specifications. Submitting "pictures" that do not meet these standards often results in immediate desk rejection or significant delays in the peer-review process.
Resolution and Print Quality
The most common mistake in preparing AMA-style figures is insufficient resolution. For medical journals, resolution requirements are typically higher than for standard web publishing:
- Photographs (Halftones): These require a minimum of 300 dots per inch (DPI) at the final size they will appear in the publication.
- Line Art: Diagrams or charts with fine lines and text require at least 1200 DPI to prevent "pixelation" or jagged edges when printed.
- Combination Images: Images containing both photographic elements and text labels should ideally be submitted at 600 DPI.
File Formats and Color Modes
While web-friendly formats like JPEG are common in casual settings, professional AMA submissions prefer "lossless" formats. TIFF (Tagged Image File Format) and EPS (Encapsulated PostScript) remain the industry standards for 2026. These formats preserve maximum detail and support layers, which are often necessary for complex medical illustrations.
Regarding color, images should be submitted in the CMYK (Cyan, Magenta, Yellow, Black) color space if the publication includes a print component. For online-only supplemental material, RGB (Red, Green, Blue) is acceptable and often preferred for its wider color gamut on modern OLED and LED screens.
Ethical Standards: Patient Privacy and De-identification
When "AMA pictures" involve human subjects, ethical considerations take precedence over technical quality. The 11th edition of the AMA Manual of Style, along with updates leading into 2026, emphasizes that patient anonymity must be protected at all costs.
The Myth of the "Eye Bar"
Historically, many researchers believed that placing a black bar over a patient’s eyes was sufficient for de-identification. In current practice, this is considered insufficient. Modern facial recognition software and the unique nature of facial structures mean that a patient can still be identified even with the eyes obscured.
The AMA guidelines now suggest that unless the eyes or the specific facial feature are essential to the clinical message of the image, the entire face should be cropped or blurred. If the face is the subject (e.g., a dermatological condition on the cheek), the author must obtain an explicit Informed Consent for Publication form, signed by the patient or a legal guardian. This is distinct from a general consent for treatment.
Identifying Marks and Metadata
De-identification extends beyond the visual content. Authors must ensure that:
- Direct Identifiers: Names, medical record numbers (MRNs), birthdays, and specific geographic locations are removed from the image.
- Indirect Identifiers: Unique tattoos, rare physical deformities, or jewelry that could identify the individual must be removed or masked.
- EXIF Data: Digital cameras and smartphones embed metadata (GPS coordinates, date/time, and device serial numbers) into image files. This metadata must be "stripped" before submission to prevent accidental privacy breaches.
Constructing AMA-Compliant Legends and Captions
A picture in an AMA-style document is incomplete without its corresponding legend (caption). The legend should allow the figure to be "self-standing," meaning a reader should understand the visual without referring back to the main text of the article.
Structure of a Figure Legend
An AMA legend typically follows a specific sequence:
- Figure Number: Bolded and followed by a period (e.g., Figure 1.).
- Title: A brief, descriptive phrase that identifies the subject of the figure.
- Methodological Details: Brief explanation of how the image was captured or what the visual represents (e.g., "Hematoxylin-eosin stain, original magnification ×200").
- Explanation of Symbols: All arrows, asterisks, or color-coding used within the picture must be defined in the legend.
- Abbreviations: Even if an abbreviation is defined in the text, it must be redefined at the bottom of the figure legend for clarity.
Accessibility and ALT Text
By 2026, accessibility is no longer optional. When preparing AMA pictures for digital publication, authors are encouraged to provide Alternative Text (ALT text). Unlike the legend, which provides context, ALT text provides a literal description of the image for screen readers used by the visually impaired. A good ALT text for an AMA figure would describe the visual trend of a graph or the specific clinical feature shown in a photograph.
Copyright, Permissions, and "Fair Use"
One of the most complex areas of managing AMA pictures is navigating copyright law. If an image was not created specifically by the authors for the current manuscript, permission must be obtained from the original copyright holder—usually the publisher of the original work, not the author.
When is Permission Required?
Permission is required for:
- Directly reproducing a picture from another published source.
- Modifying or "adapting" an existing figure. Even if you redraw a chart based on another person's data, you must credit the original source and, in many cases, obtain permission if the "creative expression" of the original is substantially similar.
- Using "stock photos" unless the license explicitly allows for scholarly publication without additional attribution.
Creative Commons and Open Access
The rise of Open Access (OA) publishing has simplified some aspects of image use. Images published under Creative Commons (CC BY) licenses can generally be reused as long as proper attribution is given. However, authors must verify the specific type of CC license, as some (like CC BY-NC) prohibit commercial use, which may conflict with the business models of certain medical journals.
| Requirement Category | AMA Specification (2026 Standards) | Common Mistake to Avoid |
|---|---|---|
| Resolution | 300 DPI (photos); 1200 DPI (line art) | Using 72 DPI "web" images |
| File Format | TIFF or EPS (Lossless) | Using highly compressed JPEGs |
| Patient Privacy | Signed informed consent for all faces | Using black bars over eyes only |
| Color Space | CMYK for print; RGB for digital-only | Submitting RGB for print journals |
| Citations | Placed at the end of the figure legend | Omitting the source for "adapted" data |
| Labels | Sans-serif font (Arial/Helvetica), 8-12 pt | Using decorative or serif fonts |
AI-Generated Imagery in 2026
As of 2026, the use of generative AI in creating "AMA pictures" is a major point of discussion in technical editing. The AMA Manual of Style has issued specific guidance regarding the use of AI-assisted visualizations.
Disclosure and Transparency
If an image or any part of a figure was created using generative AI (such as DALL-E, Midjourney, or specialized medical visualization AI), this must be disclosed in the figure legend. The disclosure should include the name of the AI tool, the version used, and the prompt (or general methodology) used to generate the image.
Accuracy and "Hallucinations"
AI-generated medical illustrations are often prone to "hallucinations"—anatomical inaccuracies that look realistic but are medically false. Authors bear the full responsibility for the scientific accuracy of AI-generated pictures. Using AI to "enhance" clinical photographs (e.g., removing a blemish that wasn't there or sharpening a blurry X-ray) is considered scientific misconduct similar to data falsification.
Troubleshooting Common Figure Issues
Even with high-quality equipment, several common issues can render AMA pictures unusable. Addressing these during the preparation phase saves time during the revision cycle.
- Contrast and Brightness: In clinical photography, especially dermatology, improper lighting can obscure the pathology. Use a neutral background (gray or blue) to ensure the camera’s auto-exposure doesn't over- or under-compensate.
- Scale Bars: For microscopic images or photographs of surgical specimens, a physical scale bar should be included within the picture. Merely stating the magnification in the legend is often insufficient because the image size may change during layout.
- Consistent Styling: If an article contains multiple charts or graphs, they should all use the same font (e.g., 10-pt Helvetica), line weights, and color palette. This provides a cohesive "technical" look that aligns with the senior editorial standards of the AMA.
- Cropping for Focus: Remove unnecessary background elements that distract from the primary subject. If a picture shows a patient's hand, do not include the hospital bed, IV poles, or floor unless they are relevant to the case.
FAQ
What is the difference between a figure and an illustration in AMA style?
In AMA style, "Figure" is the umbrella term used for all non-table visual elements. An "illustration" generally refers to a hand-drawn or digitally rendered piece of art used to explain a concept (like the mechanism of a drug), whereas a "picture" or "photograph" usually refers to a direct image captured by a camera or medical imaging device.
Can I use a screenshot as an AMA picture?
Screenshots are generally discouraged unless they are the primary subject of study (e.g., a study on a new software interface). Most screenshots are captured at 72 or 96 DPI, which is far below the 300 DPI required for professional publication. If a screenshot must be used, it should be captured on a high-resolution "Retina" or 4K display to maximize pixel density.
Do I need permission to use an image if I am the one who took the photo?
If you took the photo, you generally own the copyright. However, if the photo was taken as part of your employment at a hospital or university, the institution may technically own the rights under "work for hire" laws. Always check your institutional policy. Furthermore, even if you own the photo, you still need patient consent if the patient is identifiable.
How should I number my pictures if I have sub-parts (e.g., 1a, 1b)?
AMA style uses capital letters to denote sub-parts of a figure. For example, Figure 1A and Figure 1B. These should be clearly labeled within the image files themselves, usually in the upper-left corner of each panel, using a bold, sans-serif font.
Is it acceptable to use color in all AMA figures?
While color is encouraged in digital-first publishing to improve clarity, it should be used purposefully. Avoid "chart junk"—unnecessary colors or 3D effects that do not represent data. Additionally, ensure your color choices are color-blind friendly by using palettes that remain distinguishable for readers with protanopia or deuteranopia.
Practical Next Steps for Authors
To ensure your AMA pictures are publication-ready, start by reviewing the specific "Instructions for Authors" page of your target journal, as individual publications may have slight variations on the standard AMA requirements. Use a dedicated image editing suite like Adobe Photoshop or GIMP to verify the DPI and color space of your files before submission. Finally, double-check that every person visible in your images has a corresponding, signed consent form on file, as most high-impact journals will require you to attest to this during the upload process.
