Library News

Anatomy images are a valuable tool for sharing information in health care. They can help explain a procedure to a patient or teach a provider a new skill.

Finding a cost-free, copyright-compliant anatomy image that serves your needs can be challenging. Library Services recommends starting your search with the following resources, accessible through Library Services' Databases A-Z list and the Copyright subject guide:

• AnatomyTOOL
• Anatomy.tv

AnatomyTOOL

AnatomyTOOL (Topic Oriented Open Learning) is a platform that provides open-access materials for teaching and learning anatomy. It includes a collection of anatomy images that may be downloaded. Most are in the public domain or have Creative Commons licenses.

How to Find and Use Images in AnatomyTOOL:

For assistance using AnatomyTOOL, book a consultation with a Librarian Educator.

Anatomy.tv

Anatomy.tv is a multimedia resource featuring a robust collection of interactive 3D models of human anatomy. It is a subscription-based resource published and maintained by Teton Data Systems (TDS Health). Library Services provides access to Anatomy.tv for Nova Scotia Health staff and physicians.

You can customize Anatomy.tv images by:

• Rotating them
• Adding or removing anatomical layers
• Highlighting anatomical structures
• Adding labels

Nova Scotia Health staff and physicians may download Anatomy.tv images and use them for educational purposes, including:

• printed or digital course packs and other educational materials
• LMS courses
• presentations
• patient education materials (including patient pamphlets)

When using Anatomy.tv images, you must acknowledge the source and retain the copyright information (Primal Pictures logo) embedded on the downloaded image file.

How to Find and Use Images in Anatomy.tv:

For assistance using Anatomy.tv:

• Visit the Anatomy.tv help page.
• Book a consultation with a Librarian Educator.
• Check our Learning Opportunities calendar for regularly offered Anatomy.tv education sessions.

You can find links to these and other trusted image sources on the Copyright subject guide’s Using Images page. If you have questions about using images in your content, please contact us at Copyright@nshealth.ca.

Lana MacEachern

Library Technician
Pictou/Colchester-East Hants/Cumberland Region

Q: I am adapting a Nova Scotia Health form and want to include an image that is used in the existing version of the form. The image is not cited, and I don’t know where it came from. Can I use it, since no one has ever complained?

A: Just because an image was used previously, it doesn’t mean it was used with permission. Even if you think the chance of someone complaining is slim, you must comply with copyright law.

Here’s what you should do:

1. Try a reverse image search in Google Images to look for the source/copyright owner of the image. Watch the tutorial video below for tips on reverse image searching.
2. If you find the image, review the terms of use to determine if your use is permitted.
3. If written permission or payment is required, you must comply with those terms before using the image.
   1. Please submit proof of permission to our permissions repository.
   2. If the fee is too high or permission is not granted, look for a free-to-use alternative.
4. Always cite the source of an image, even when it is not required. This will prevent having to repeat these steps the next time the form is revised.

If you are unable to find the image or need help with this process, reach out to Library Services: Copyright@nshealth.ca.

Q: I am developing a document for a clinical subject guide for staff. I found an image in a journal article that is perfect for my needs, but I must pay to use it. Since I don’t have a budget for this, can I create my own image that looks basically the same?

A: You can create something similar, but it cannot be identical or have only minor differences. Your image must be different enough to be considered an original work. You cannot trace or use photo-editing tools to manipulate the original image.

Consider:

• searching for a free-to-use or open-licensed alternative. Many of these images can be edited, but remember to check the terms of use. Visit the Using Images page of the Copyright subject guide for ideas.
• linking to the original image instead of copying it.

For more information, email Copyright@nshealth.ca or visit our Copyright subject guide.

Reverse Image Search Tutorial

Nova Scotia Health, 2024.

Lana MacEachern

Library Technician
Pictou/Colchester-East Hants/Cumberland Region

Roxanne MacMillan

Librarian Educator
Halifax Infirmary, Central Zone

The Patient Education Pamphlets team has a small collection of anatomical diagrams and icons available to include in patient education pamphlets. If you need a diagram of a particular body part or system, the team may be able to help you find something suitable. If you would like to add a specific visual element to your pamphlet:

2. It must be representative and respectful of Canada’s diverse populations.
3. It must follow applicable Canadian copyright law. Find more information about this by visiting the Using Images and Permissions pages of the Copyright subject guide.

Did you know? Nova Scotia Health team members must pay to use stock images from websites like Getty Images, iStock, and Shutterstock. Be cautious when assuming something is “free” to use. An image may be labeled “royalty free”, but still require payment for use. For more information, visit the Copyright subject guide.

4. All images submitted for inclusion in a patient education pamphlet must be high resolution. This means they should be greater than 300 pixels per inch or a .jpg file with a file size of around 1 to 1.5 MB.
   TIP To avoid your image being compressed when sending, do not add it to a Word document; send it as an email attachment or use MOVEIt (https://sfts1.gov.ns.ca/) to share the file(s) with a Patient Education Pamphlets team member (Important: the email account Pamphlets@nshealth.ca cannot receive MOVEit files).

Many Canadians struggle to read and understand health information. Adding visual elements to patient education pamphlets is one way to help improve communication between health care providers and patients, and help the material be more inclusive of those with low health literacy.

The Patient Education Pamphlets Team is happy to help make sure your patient education materials are easy to read and understand, including helping you choose the right icons, diagrams, or photographs. Reach out to us at Pamphlets@nshealth.ca or visit the Content Creator Toolkit to get started.

References

1. Park, J., & Zuniga, J. (2016). Effectiveness of using picture-based health education for people with low health literacy: An integrative review. Cogent Medicine, 3(1). https://doi.org/10.1080/2331205X.2016.1264679

2. Schubbe, D., Scalia, P., Yen, R. W., Saunders, C. H., Cohen, S., Elwyn, G., van den Muijsenbergh, M., & Durand, M.-A. (2020). Using pictures to convey health information: A systematic review and meta-analysis of the effects on patient and consumer health behaviors and outcomes. Patient Education and Counseling, 103(10), 1935–1960. https://doi.org/10.1016/j.pec.2020.04.010

3. Tiwari, R. R., Pandey, B., & Chaudhari, K. S. (2023). Image-Based Communication for Strengthening Patient Health Education in Rural and Underserved Settings. Cureus, 15(7), e41279. https://doi.org/10.7759/cureus.41279

Kallen Rutledge

Librarian Educator, Patient Education Pamphlets Lead
Nova Scotia Hospital, Central Zone

Welcome to summer—the season of pedicures, fancy up-do hairstyles and vibrant outfits. It seems everyone is getting dressed up and made over for a prom, wedding, trip or reunion.

Library Services’ Copyright Team didn’t want to be left out of the fun, so we’ve jazzed up our favourite LMS course: Copyright 101.

Copyright 101 delivers the core information you need to confidently reuse, create and share content legally and ethically at Nova Scotia Health. After taking this self-guided eLearning course, you will be able to:

• Understand the following concepts and their application in the workplace:
  • Intellectual property
  • Canadian copyright law
  • Content
  • Copying
  • Public Domain
  • Fair Dealing
• Know when and how to request permission to reproduce content
• Interpret terms of use and Creative Commons licenses
• Adapt content for reuse in Nova Scotia Health projects
• Share content ethically

The best part about Copyright 101 is you can take it at your convenience. If our regularly scheduled live copyright education sessions don’t fit your schedule, Copyright 101 is the solution.

To access the course, sign in to LMS and search for Copyright 101 by title or by the course code 0829.

We recognize that eLearning isn’t the best format for everyone. If you prefer in-person learning, you can:

• sign up for a live copyright education session (resuming in the fall)
• book a copyright consultation
• reach out to the Copyright Team at Copyright@nshealth.ca

Lana MacEachern

Library Technician
Pictou/Colchester-East Hants/Cumberland Region

In our previous Copyright Corner post, we discussed the importance of citation and promised to address copyright attribution. This post might have left you wondering....

Aren't citation and attribution the same thing?

Citation and attribution are closely related terms, often used interchangeably. In fact, academic citation is a form of attribution, used to acknowledge the author(s) of a work from which you have quoted or paraphrased a small amount of content.

But you may have to provide attribution to an author or copyright owner in a different (or additional) way if:

• it is legally required by the terms of an open license,
• the terms of use (website or other) specify how attribution should be given, or
• you are asked to do so when you receive permission to use or adapt a copyright-protected resource.

Open licenses

Copyright owners can apply open licenses to their work to give permission to use or adapt as the license specifies. Open licenses may be used for any type of resource, including:

• Artistic works, such as photographs
• Clinical tools and informational materials
• Open educational resources, such as online courses and textbooks
• Databases/datasets

The best-known open licensing system is Creative Commons, which we have discussed in a previous blog post. The minimum requirement of each of the six types of licenses is attribution.

Attribution statements for open-licensed resources should include the title of the work, the name of the author/creator, and the license type, with hyperlinks to each where applicable (Aesoph, n.d.).

Note that although there is no legal requirement to give attribution to the author(s) of a Public Domain or CC0-dedicated resource, it is good practice to do so. Not only does this acknowledge someone else's work, it also tells your readers where to find the original (Kat, 2015).

You can find examples of Creative Commons attribution styles on their Best practices for attribution page. Also useful is Open Washington’s Open Attribution Builder, which allows you to enter information about a resource to generate an attribution statement.

Terms of use

Sometimes, the creators of a website or other resource will explicitly tell you how to attribute their content. Look for language such as:

• Terms of use
• Terms and conditions, or
• Copyright

in the fine print at the bottom/footer of webpages.

These terms should be interpreted as a legal agreement between you and the copyright owner (ContractsCounsel, nd.). Failure to comply could lead to a take-down request or even legal action against you or your employer.

For example, the Australian Urban Research Infrastructure Network (AURIN) (n.d.) specifies:

Permission

When you request permission to use a copyright-protected resource, the copyright owner may say yes on the condition that you provide attribution in a specific way. Sometimes, they will just ask you to provide a citation, but quite often they will require you to use attribution terminology such as:

• Adapted with permission from ...., or
• Used with permission from ....

We will discuss the permissions process in depth in the next Copyright Corner post. For now, when you request permission, it is always a good idea to ask the copyright owner if they have any conditions for how the work can be used, including how it should be attributed.

A few things to note

The differences between citation and attribution are subtle. Here are some things to keep in mind:

• Attribution is generally a condition of permission to use all or part of a resource (Aesoph, n.d.)
• Attribution statements, particularly for images and figures, are usually placed on the same page as the resource, rather than in a reference list (Aesoph, n.d.)
• If you are quoting from or paraphrasing part of a resource and want to direct your readers to your reference list with in-text citations, you may choose to provide both an attribution statement AND a reference.

You can read more about this and other copyright topics in our Copyright subject guide. If you have questions, you can book a consultation with a library team member or email us at copyright@nshealth.ca.

Attribution

Some information is adapted from Self-Publishing Guide by L.M. Aesoph, published by BCcampus Open Education and used under the conditions of a CC BY 4.0 International License.

References

1. Aesoph, L.M. (n.d.). Self-Publishing Guide. BCcampus Open Education. https://opentextbc.ca/selfpublishguide/

2. Australian Urban Research Infrastructure Network (AURIN). (2022, July 1). Copyright and attribution. https://aurin.org.au/legal/copyright-and-attribution/

3. ContractsCounsel (n.d.). Website terms and conditions. https://www.contractscounsel.com/t/us/website-terms-and-conditions

4. Kat (2015, February 25). Why Creative Commons uses CC0 [blog post]. Creative Commons https://creativecommons.org/2015/02/25/why-creative-commons-uses-cc0/

Roxanne MacMillan

Librarian Educator
Central Zone

UPDATED: June 10, 2024

If a picture is worth a thousand words, then is a video worth a million? We like to think so!

Library Services provides Nova Scotia Health staff with access to full-text ebooks, ejournals, and articles. Did you know you can access procedural videos as well? If you are looking for a visual refresher on how to perform a procedure, BMJ Best Practice and ClinicalKey® have you covered.

BMJ Best Practice

Our access to BMJ Best Practice includes videos on common clinical procedures. Each video is accompanied by a list of equipment, complications, indications, contraindications and aftercare.

Browse a list of procedural videos

1. Go to the Library Services Databases A-Z page. Enter BMJ in the search box, then click on the Go button; or select B from the Databases A-Z alphabet list.
2. Click on the BMJ Best Practice link.
3. From the BMJ Best Practice home page, select Multimedia (A) from the menu bar, then Videos.

Locate videos on a specific subject
As an example, let’s search for "osteoporosis":

1. Go to the BMJ Best Practice home page (as in steps 1 and 2 above).
2. Enter "osteoporosis" in the search box, then click on the search icon.
3. In the search results screen for "osteoporosis", click on the Signs & symptoms link (B).

Under the Resources heading (C), you will find a link to Images and videos (D) on your specific subject.

Note: Most, but not all, subjects and procedures in BMJ have accompanying images and videos.

ClinicalKey®

ClinicalKey’s procedure videos provide step-by-step visuals for dozens of procedures. Each video is accompanied by instructive text, images, and equipment lists. 

Browse a list of procedural videos

1. Go to the Library Services Databases A-Z page. Enter ClinicalKey in the search box, then click on the Go button; or select C from the Databases A-Z alphabet list.
2. Click on the ClinicalKey link.
3. On the ClinicalKey home page, scroll down to the Deepen your specialty and medical knowledge section, then click on the link for Procedure Videos (E). 

Note: You can browse the resulting list of videos alphabetically (F) or by specialty (G).

Locate videos on a specific subject 
As an example, let’s look for "nasogastric tube placement":

1. Go to the ClinicalKey® home page (as in steps 1 and 2 above).
2. To the left of the search box, click on the All Types drop-down menu and select Procedure Videos (H). 
3. Enter "nasogastric tube placement" in the search box, then click on the Search button (I).

TIP When you click on the link for a procedure video, there is a double arrow ⤢ in the top-right corner of the screen. Click on the arrow to open ‘reading mode.’ This makes the accompanying text larger so it is easier to read.

Copyright considerations

Like other forms of information, procedural videos are protected by copyright. You must have permission and/or give recognition to the creator to be able to reuse and/or share them. Permissions differ by resource. Before using any video, check the copyright permissions for the video. 

TIP For most databases, copyright permissions can be found under the Terms and Conditions link (J) at the bottom of the home page. If you have questions, reach out to copyright@nshealth.ca. 

Procedural videos are great visual tools to help refresh your skills. BMJ Best Practice and ClinicalKey® both have an extensive selection of videos to meet your clinical practice and research needs. If you would like more information on procedural videos, reach out to AskLibrary@nshealth.ca, or book a one-on-one consultation with a team member. We are always here to help!

Amanda Andrews

Librarian Educator, Education & Training Lead
Eastern Zone - Cape Breton, Guysborough, Antigonish

“[Creative Commons’] founders recognized the mismatch between what technology enables and what copyright restricts, and they provided an alternative approach for creators who want to share their work. Today that approach is used by millions of creators around the globe.” (Creative Commons, n.d., Unit 1)

Understanding how to reuse someone else’s work legally is complicated. Using works made available under Creative Commons licenses is a (fairly) straightforward way to navigate terms of use, permissions, and the details of Canadian copyright law. Let’s take a closer look!

What is Creative Commons?

Founded in 2002, Creative Commons (CC) is a nonprofit organization committed to open licensing. They provide creators, worldwide, with “a free, simple, and standardized way to grant copyright permissions for creative and academic works; ensure proper attribution; and allow others to copy, distribute, and make use of those works.” (Creative Commons, n.d.2).

It is important to understand that, although CC-licensed resources are free to use, there are some restrictions and attribution is always required. You must carefully read and understand the terms of the CC license and use the resource as specified.

Understanding Creative Commons Licenses

There are six Creative Commons licenses. From least restrictive to most restrictive, they are:

	Attribution CC BY	You can distribute, remix, adapt, and build upon a work, even commercially, as long as attribution is given to the original creator of the work.
	Attribution- Sharealike CC BY-SA	You can distribute, remix, adapt, and build upon a work, even commercially. Attribution must be given to the original creator and modified works must also be licensed CC BY-SA.
	Attribution- NoDerivatives CC BY-ND	You can reuse a work for any purpose, even commercially, but no modifications or adaptations are allowed. Attribution must be given to the original creator of the work.
	Attribution- NonCommercial CC BY-NC	You can remix, adapt, and build upon a work, but the use must be non-commercial. Attribution must be given to the original creator of the work.
	Attribution- NonCommercial- Sharealike CC BY-NC-SA	You can remix, adapt, and build upon a work, but the use must be non-commercial. Attribution must be given to the original creator and modified works must also be licensed CC BY-NC-SA.
	Attribution- NonCommercial- NoDerivatives CC BY-NC-ND	You can download and share a work, but it cannot be modified or adapted or used commercially. Attribution must be given to the original creator of the work.

License icons by Creative Commons / CC BY 4.0

Creative Commons also provides public domain tools that help creators make their work available without copyright restrictions.

Places to Find Creative Commons Licensed Content

Openverse

This search engine, linked on the CC website under “Search the Commons” and maintained by WordPress, allows you to search for CC-licensed content across the web. You can filter by the type of license or by intended use (commercial, modify/adapt).

Flickr

Flickr is a photo management and sharing site, with billions of photographs. You can limit your Flickr search results to CC-licensed images.

Wikimedia Commons

Many of the 80 million+ media files uploaded to Wikimedia Commons are CC-licensed. Be sure to check the license/terms of use for each resource and provide attribution as required.

Google Images

Google Images allows you to limit your search to CC-licensed images.

Once you have entered your search terms, in this example "human heart", click on Tools (1) to open a menu. Click on Usage Rights (2) and select Creative Commons licenses (3).

It is important to note that not all images retrieved this way are actually CC-licensed. Always check the source of the image to make sure you can use it without payment or permission.

Bing Images/Microsoft Office

To limit your Bing Images search to Creative Commons or Public Domain, click on Filter (1). Then click on License (2) and select the type of license from the dropdown menu (3). Bing’s filter allows you to be more specific than Google.

Microsoft Office allows you to insert online pictures through an integrated Bing Images Creative Commons search.

As with Google Images, the Bing Images/Microsoft Office Creative Commons search is NOT 100% reliable. Always check the source of the image to ensure if and how you are permitted to use it.

What does it mean to give a creator attribution?

Attribution is a requirement of all CC licenses. Creative Commons (n.d.3) states that an ideal attribution includes the:

• Title of the resource (with a link to the source)
• Author/creator (with a link to their profile page)
• CC License (with a link to the license details)

See the Creative Commons Best Practices for Attribution wiki for more details. 

When you insert a CC-licensed image in a Microsoft Office project, a generic attribution will be included. 

To obtain the correct title, author and license details , you will need to click the text This Photo (1) to view the original image. Replace the generic text with the actual title (linked to the source) and the author’s name (2) (linked to their profile, if available). Check to make sure that the CC license (3) is correct. The correct attribution (4) for this example is:

Doctor greeting patient by Vic is licensed under CC BY.

For more information about Creative Commons licenses and other copyright topics:

• visit our Copyright subject guide.
• reach out to us with your copyright questions using our new copyright email – copyright@nshealth.ca
• book a one-on-one consultation with a Library Services team member.
• check our Learning Opportunities and Events calendar for upcoming copyright education sessions.

References

1. Creative Commons. (n.d.1). Creative Commons Certificate for Educators, Academic Librarians and GLAM. https://certificates.creativecommons.org/cccertedu/

2. Creative Commons. (n.d.2). What we do. https://creativecommons.org/about/

3. Creative Commons. (n.d.3). Use & remix. https://creativecommons.org/about/

Roxanne MacMillan

Librarian Educator, Copyright
Dickson Building, Central Zone

In today’s digital world, finding and using images for presentations, education, and publication is easy…

Or is it?

People often assume that online images are free to use, perhaps because they are so easily available: Right click and save, then copy and paste into your work.

In reality, using online images is complicated because some images:

• are free to use
• can be used with permission, or under specific terms or licences
• must be purchased
• cannot be reproduced under any condition

You should always assume that an image is protected by copyright, and it is always your responsibility to find out if and how you are permitted to reproduce it legally and ethically.

We’ve created an infographic to help you with reusing and/or adapting images in your work.

Key considerations

• Fair dealing

What uses are considered ‘fair’ under Canadian copyright law? Can you use any image in any educational presentation if you cite the source?

• Creative Commons licences

A Creative Commons licence does not mean that content can be used without restrictions. There are six different licences, each with their own terms of use.

• Public domain

What does it mean when something is in the ‘public domain’?

• Getting permission

The permissions process can seem overwhelming, but it must be followed. What are the best practices for requesting permission? What do you do if you can’t find a copyright owner? What do you do if the owner says “no”?

Look for future blog posts, where we will explore each section of the infographic in more detail.

Visit our Copyright subject guide for more information about finding and legally using images, or book a consultation with a library team member (choose “Copyright” from the list of options). If you find you still have questions about using images, email us at AskLibrary@nshealth.ca.

Roxanne MacMillan

Librarian Educator
Library Services, Central Zone

UPDATED: June 7, 2024

It can be challenging to find medical images that are technical and specific to a certain discipline. You may be looking for a medical image to add to a patient education pamphlet, LMS module, or staff training presentation. While some resources are great for finding general images and icons, ClinicalKey® is a valuable tool for finding medical images that are derived from full-text information sources such as journal articles and ebooks. Read on to learn how to find images in ClinicalKey® and use them in accordance with copyright.

What is ClinicalKey®?

ClinicalKey® is a biomedical database that contains a wealth of content in a variety of formats. In addition to medical images, ClinicalKey® also contains journal articles, ebooks, clinical overviews, drug information, and procedural videos. Library Services subscribes to ClinicalKey®—you can access it from our Databases A-Z list.

Note: When accessing ClinicalKey® offsite or on a computer not connected to the Nova Scotia Health network, you may be prompted to enter your Nova Scotia Health username and password.

Searching for images in ClinicalKey®

On the ClinicalKey® homepage, type a keyword (e.g. suturing) into the search bar (1), select “Multimedia” from the drop-down menu (2), and click on the icon (3).

Note: In ClinicalKey®, “Multimedia” refers to both images and videos, so your search may return results in both formats. To limit your search results to images only, deselect the “Videos” filter from the menu on the left (4) by unchecking the box.

You can change the view between “Grid” and “List” using the View drop-down menu (5), and sort your results by “Relevance” or “Date Published” using the Sort by drop-down menu (6). You can also further refine your search results using the Specialties or Date filters (7) from the menu on the left-hand side.

Another way to search for images in ClinicalKey® is to browse by broader specialty. On the homepage, under Deepen your specialty and medical knowledge, select “Multimedia”. On the results page, you can then select a specialty (such as anatomy) from the menu on the left (8), or click on “More Specialties” (9) to expand the list, if needed.

Don’t forget about copyright!

When searching for a medical image, it’s important to think about how you intend to use the image. Images in ClinicalKey® can be used in presentations for non-commercial purposes, but the presentation slides cannot be posted anywhere. To use an image for a purpose other than a presentation (e.g. in a patient education pamphlet or an LMS module), you must find out the specific terms of use, which will reflect the terms for the larger body of work in which the image is found (e.g. a journal article). Find out what an image’s terms of use are by clicking on “View in source” (10), scrolling to the top of the page, and clicking on “Get rights and content” (11). The Copyright Clearance Center's RightsLink® page will open and list any applicable copyright restrictions, allowing you to request permission to use an image, if needed.

Add to Presentation feature

When searching ClinicalKey® for images to include in a presentation, the Add to Presentation feature may be helpful. It lets you add images to a presentation folder, then export the folder as a PowerPoint file. Simply click on the   “Add to Presentation” icon (12) for any image. You can then create a new presentation folder or add the image to an existing folder.

To view and export your presentations, open the menu    in the top-right corner of the screen and click on “Presentations”. On the Presentation Maker page, click on “Export”. Your PowerPoint presentation should now be in your downloads folder. Image details such as citations, captions, and copyright statements are automatically added to the PowerPoint slides and cannot be edited.

Note: To use the Add to Presentation feature, you must be logged in to a personal ClinicalKey® account. You can create an account by clicking on “Register” in the top-right corner of the page. If you already have a personal account in another Elsevier product (e.g. Mendeley), you can use the same username and password to log into ClinicalKey® without creating a new account.

Remember: Images from ClinicalKey® can be used in presentations for non-commercial purposes. You do not need to request permission to use images in this way, but you cannot post the presentation slides anywhere. For any other use, you must adhere to the image’s terms of use, and request permission to use the image, if necessary. 

For more support with finding and using images, visit our Copyright subject guide or reach out to us at Copyright@nshealth.ca.

Kristy Hancock

Librarian Educator

Not all patient pamphlets need illustrations

The goal of a patient pamphlet is to ensure that patients understand the medical issue they are facing, and the instructions provided by their clinician. As a content creator, you may wish to add illustrations to your pamphlet to enhance patient understanding. For example, a pamphlet on tonsillectomy and adenoidectomy may include a diagram of the head with the adenoids, tonsils, and lingual tonsils labelled. A pamphlet on hip surgery may include a diagram of the structure of the hip.

Illustrations should not be used if they are not critical to enhancing patient learning

Illustrations should not be included:

• to make a pamphlet look attractive or 'flashy' 
• if you do not have copyright permission to use the illustrations (Learn more about image copyright.)
• if the illustrations were chosen without consideration of diversity and/or inclusion
• if you do not have high resolution image files (e.g. greater than 300 pixels per inch or a JPEG with a file size of around 1 to 1.5 MB)

When in doubt, keep it simple! Illustrations can be both helpful and distracting. When illustrations are done poorly, they can lead to patient confusion.

If including illustrations is critical to enhance patient learning, you will need to decide whether you would like the pamphlet to be printed in black and white or in colour. The front and back covers (the ‘shell’) of all Nova Scotia Health pamphlets printed at the Print Shop include coloured branding. However, you may choose to have the rest of your content, including any extra images or logos added to the cover, printed in black and white or colour.

The Patient Education Team can only send one version of a pamphlet to the Print Shop, either black and white or colour. Please take time to decide whether the content of your pamphlet (including added images or logos on the cover) needs to be printed in colour, since this may significantly increase the cost per copy. Selecting colour also means that if you want black and white copies in the future, you will need to specifically request this from the Print Shop. Remember, you can request a quote from the Print Shop before placing your order.

If you have any questions about creating patient pamphlets, please visit the Content Creator Toolkit. You can also reach out to the Patient Education Team or to Library Services, or book a consult with one of our team members. We're here to support you throughout the process! 

Reference:
Collier R. (2011). Educating patients with pictures. CMAJ: Canadian Medical Association Journal, 183(15), E1094. https://doi.org/10.1503/cmaj.109-3967

Jackie Zoppa

Library Technician, Patient Pamphlets
Nova Scotia Hospital, Central Zone

Updated: June 12, 2024

The right image can brighten up your content or reinforce a message you are trying to convey. It’s not always realistic to create or commission the perfect image when developing content for education, research, and the workplace, so people often reuse or adapt existing images to meet their needs. It’s easy to run a Google image search, but there are better places to search for images that will deliver higher quality files and clear guidance about reuse, adaptation, and attribution.

Images are Protected by Copyright

Images are a form of intellectual property. Keep in mind that copyright protection of intellectual property is automatic under Canadian copyright legislation. Material doesn’t have to include the copyright symbol (©) for it to be protected. Only copyright owners have the immediate right to reuse and adapt their work (NSHA Copyright & Intellectual Property Policy, 2022).

It’s important to check the image source for information about the creator or copyright owner’s terms. This information may be clearly displayed alongside the image information or you may have to search the source’s website for a section called Terms of Use, Terms & Conditions, Copyright Statement, etc.

If you find an image with a clear watermark on it, it’s not OK to reuse or adapt the image without permission from the copyright owner. If you can’t find a copyright statement, or you locate a statement that doesn’t cover how you want to reuse or adapt the image, connect directly with the copyright owner, get permission and document it. Simply send an email to the source’s general inbox and clearly state what you want to reuse and how you want to reuse it.

Creative Commons & Noun Project

There are several online resources to help you reuse and adapt images ethically. Creative Commons image search helps you look for images that are in the public domain or under a Creative Commons license. Use the search results filter to check a Modify or adapt box if you intend to alter the image. Check the Use commercially box if you will profit from reuse of the image.

"Wheelchairs for visitors at the entrance - NÄL hospital" by aka CJ is licensed under CC0 1.0

Let’s say you want to find images of wheelchairs that you can modify and add a cat to – try searching wheelchairs here. On the results page, select only the Modify or adapt box. Choose an image from the filtered results and investigate the permissions. Below an image, are the details about how you can use the image. This wheelchair image  is shared under a CC0 1.0 license. This means we can copy, modify (add a cat), or distribute the image (even for commercial purposes) without asking permission. Although attributing the source of the image is not required in this case, doing so shows professionalism and respect for the content creator. Select Credit the creator below an image to get a citation you can copy and paste into your work.

Noun Project is a great place for finding icons. While you need a subscription to reuse some icons without attribution and to change icon colours, you can create a free account to access black and white icons and attribute them as outlined for each image. 

"wheelchair" by Smalllike is licensed under CC BY 3.0

Let’s search for wheelchairs. This image looks good. To reuse it, we need to consult the CC Attribution License information (visible when logged in with your free account). When downloading the image, including an embedded citation, we're instructed to give attribution to the creator and can copy the citation provided.

Voilà!  

Images from Subscription Databases

Library Services subscribes to a number of resources for staff and physicians that contain images. Anatomy.tv and ClinicalKey® are two subscription resources that have great images you can reuse, as long as you follow each resource’s terms. Images from Anatomy.tv can be used for educational purposes, provided you include the copyright information (©Pharma Intelligence UK Limited (Citeline)(2024)) and a link to the site's Terms & Conditions page. In ClinicalKey®, you can use the Presentation tool to export images to a PowerPoint presentation; the attribution is automatically included for you.

Next time you’re looking for images to add to your content, whether it’s a patient education pamphlet, policy, LMS module or original research, skip the Google image search and start with image resources recommended by Library Services in our Copyright subject guide. Remember to investigate permissions for any images you want to use, follow terms set by the copyright owner, and ask for specific permissions when necessary.

Katie McLean

Librarian Educator, Education & Outreach
Dickson Building, Central Zone