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The Pⁿ Blog is a forum for opinions, questions, controversies, and instructive discussions across the field of pathology and its relevant subspecialties.
Wednesday, January 26, 2011
Tips for would-be authors #2 - Illustrations.
As promised, a few more tips, this time dealing with illustrations.
 
At the risk of stating the extremely obvious, pathology is an inherently visual specialty.  I often have to remind the journal production staff of this as they try to shrink critical figures to fit into spaces that are much too small.  The key to convincing reviewers and readers that your entity has been properly interpreted often lies entirely with the figures. 
 
In the "not so good old days" when you wanted to illustrate a manuscript, you took your handful of glass microscopic slides to the hospital's medical illustration department.  There, a photographic expert worked with you to produce nearly perfect images, typically on an extremely nice, state of the art photomicroscope.  You picked the field and the magnification and the photo assistant often did everything else including checking the focus and setting the Köhler illumination and light intensity.  Large 4" x 5" negatives were often used, giving superb resolution and the photo assistant carefully printed your picture, manipulating the exposure time, contrast, and dodging/burning the print to produce even lighting.  The result was typically a perfect or near perfect black and white image.
 
Today, your medical illustration department has probably been phased out, a victim of the advent of color digital photography, PhotoShop, and PowerPoint.  The digital photographic equipment that exists today is of unparalleled quality and comes at increasingly lower prices.  This, coupled with the wide availability of easy to use image software, means that photos submitted for publication today should be essentially flawless.  Yet, sadly, they are often worse than those submitted in the pre-digital era.  In large part, I believe this is due to the fact that you no longer have photographic experts to help you.  Now YOU must be the expert.
 
Most authors do well with focus, but they often fall woefully short with regard to brightness, color balance, contrast and uniform lighting.  Most of these problems can avoided up front by properly adjusting the microscope and setting the color balance before taking the photomicrographs.  Less than perfect figures can be adjusted with image software such as PhotoShop.  The goals for the end result are simple.
 
1. The background should be white or very light gray, not green, blue or yellow.
2. The image should have sufficient contrast and not appear washed out.
3. The image should have a uniform brightness across the field without dark corners.
 
Adjusting brightness and contrast is typically easy.  Adjusting color balance takes a little more practice.  Uneven lighting (usually dark corners) can be corrected by "dodging" the corners.  Areas that are too light can be "burned."  These are techniques well known to pre-digital film-based amateur photographers but they are easily done by virtually anyone with current software.  LEARN THEM!
 
Don't be afraid to try these techniques.  Often when I ask authors to improve their illustrations the revised photos are a step in the right direction but go only about 10% of the way toward what is needed.   For each change that you make to a figure, it is best to purposefully go a little too far in the direction needed and then "back up" to what appears best, rather than making small incremental changes.  It also helps to walk away from the figure for a while and then come back to it, as you eye tends to compensate for errors over longer periods of time. 
 
It is critical to emphasize, of course, that the purpose of editing a photo is to make it a more faithful rendition of what is seen through the microscope.  These techniques must NOT be used to create a false reality.  For example, contrast, brightness and color balance should not be manipulated to make weak immunohistochemical staining look stronger than it really is.
 
Authors need to carefully chose the magnifications that they use.  Low-power images are important to show the overall context of the lesion.  High-power images are needed to show the cellular makeup of the lesion in more detail.  The authors should repeatedly ask themselves if they have documented the lesion in sufficient detail to allow the reader to recognize it when encountering it in their own practice.  As mentioned above, poorly illustrated manuscripts cause reviewers (and readers) to question the correctness of the diagnosis.
 
Finally, a word about color submission format.  Most of us manipulate color images in RGB (red-green-blue) format.  This is fine for PowerPoint or any other electronic usage.  However, at some point when an image is going to be printed on paper it must be converted to CMYK (cyan-magenta-yellow-black) format.  This format corresponds to the available inks used in printing.  Typically converting an RGB image to CMYK results in only minimal alteration in color balance, but occasionally the changes can be more dramatic. For this reason, it is always BEST to submit an image for printing as CMYK, although most of the time the conversion is not noticeable. 
1/27/2011
Dr. JAIME A. MEJIA said:
Thanks Dr. Mills for sharing this tips. Just to remind that the ImageJ application, by NIH I guess, is a free downloadable tool, it requires some tutorial time and reading about the principles of digital imaging but is a handy tool to deal with path images. Jaime A Mejia, MD
About the Author

Stacey E. Mills, MD
Stacey E. Mills, MD, a graduate of University of Virginia (UVA) and the UVA Medical Center, has authored nearly 230 articles, 20+ books, atlases and monographs—including the renowned Sternberg's Diagnostic Surgical Pathology. He has been a practicing Professor and Staff Pathologist at UVA for 30+ years and is Director of Surgical Pathology and Cytopathology. His clinical specialty is general surgical pathology with emphasis on neoplasms and neoplasm-like lesions. Dr. Mills is also Editor-in-Chief of The American Journal of Surgical Pathology.