Ethical use of clinical images

To publish personal data or photographs of patients in a clinical case or other article in a scientific journal, several ethical and legal requirements must be met to guarantee the patient’s privacy, dignity, and autonomy:

  1. Written informed consent: It is mandatory to obtain a signed informed consent from the patient (or their legal representative, if the patient is a minor or unable to make decisions). This document must specify that publication of clinical information and/or identifiable images for academic purposes is authorized. The consent must be specific for scientific publication, not only for medical treatment.
  2. Ethics Committee approval: In many cases, especially when the case involves sensitive details or risk of identification, review and approval by a Research Ethics Committee or Institutional Review Board (IRB) is required.
  3. Protection of patient identity: Even when consent is obtained, every effort must be made to protect the patient’s identity. This includes:
    • Pixelating or hiding any identifiable data in images (e.g., faces, unique tattoos, distinctive marks).
    • Avoiding inclusion of names, identification numbers, exact dates, or other details that could allow direct identification.
    • Slightly modifying easily identifiable demographic details (e.g., approximate age instead of exact age, region instead of specific city).
  4. Justification for the need of identifiable images or data: Journals often require justification for why it is necessary to include images or data that could identify the patient. The image must be essential to illustrate a key aspect of diagnosis or treatment.
  5. Compliance with local and international regulations: Local personal data protection legislation must be respected (e.g., GDPR in Europe or HIPAA in the U.S., depending on location). Additionally, it is recommended to follow the publication guidelines of organizations such as the International Committee of Medical Journal Editors (ICMJE), which establishes clear standards for the use of patient images.
    In summary: Written informed consent + anonymization whenever possible + ethical approval if applicable + clinical justification.
    If consent is not available, no image or data that could identify the patient should be published, even if the case is of great scientific interest.