It is not acceptable to enhance, obscure, move, remove, or introduce a specific feature within an image. Adjustments of brightness, contrast, or color balance are acceptable if and as long as they do not obscure or eliminate any information present in the original. Manipulating images for improved clarity is accepted, but manipulation for other purposes could be seen as scientific ethical abuse and will be dealt with accordingly.In consideration of this, we do not permit the use of AI or AI-assisted tools to create or alter images in submitted manuscripts. The only exception is if the use of AI or AI-assisted tools in the creation or alteration of images is part of the research design or research methods. If this is done, we require a clear description of the content that was created or altered, an explanation of how the AI or AI-assisted tools were used in the creation or alteration process, and the name of the model or tool, version and extension numbers, and manufacturer.