| To facilitate the improvement of image processing standards and the prevention of image-related academic misconduct in Chinese biomedical journals, this study employed web-based survey and content analysis methods to systematically review the policy requirements concerning five dimensions (format and technical specifications, editorial processing, copyright and permission, patient privacy protection, and AI application) for manuscript images across eight representative international biomedical journals (NEJM, JAMA, BMJ, The Lancet, Nature, Science, PNAS, and IJC) as well as the ICMJE Recommendations from June to August 2026 . The results show that all journals and ICMJE have established systematic policies across the five dimensions: requirements for image format and technical specifications are well-developed, all adhere to the common principle of “restoring original data and prohibiting selective manipulation” in editorial processing, with some journals having established image screening mechanisms; obtaining written permission for third-party images has become a universal rule in copyright; in patient privacy protection, clinical medical journals have developed standardized requirements that prohibit the use of black bars over patients’ eyes and require informed consent for publication; in AI application, differentiated strategies of strict prohibition, exception exemption, and transparent disclosure have emerged, yet a strong consensus has been formed on the principles of “disclosure upon use and full author responsibility”. Drawing on institutional trust theory, the policy frameworks operate through clear rules, transparent procedures, and enforceable sanctions to construct a traceable academic trust mechanism. It is recommended that Chinese biomedical journals establish systematic image processing standards and adopt transparent disclosure as a key principle in image policies, while taking into account the current reality of Chinese authors’ insufficient awareness of these standards and adopting a gradual path of “establishing rules before implementing strict screening”, and simultaneously advance the integrated governance ecosystem comprising technical screening, ethical education, and disciplinary mechanisms. |
