diff --git a/public/js/assistant/images.js b/public/js/assistant/images.js
index b5110122..da5d8976 100644
--- a/public/js/assistant/images.js
+++ b/public/js/assistant/images.js
@@ -285,7 +285,7 @@ async function imageSourceToBlob(src) {
 export function buildContextualImagePrompt(request, lastAnswer) {
   var prompt = String(request || '').trim();
   if (!lastAnswer) return prompt;
-  var answer = String(lastAnswer || '').replace(/\[\d+(?:\s*,\s*\d+)*\]/g, '').slice(0, 3000);
+  var answer = String(lastAnswer || '').replace(/\\?\[(?:\^?\d+(?:\s*,\s*\^?\d+)*)\\?\]/g, '').slice(0, 3000);
   return prompt + '\n\nUse this clinical answer as the required context. Do not switch topics or introduce unrelated scenes such as gardening. Create a medical teaching visual faithful to the answer. Do not include citations, reference numbers, footnotes, source lists, or named organizations; do not invent references.\n\nAnswer:\n' + answer;
 }
 
diff --git a/src/routes/clinicalAssistant.js b/src/routes/clinicalAssistant.js
index 9e45e658..72e71d6d 100644
--- a/src/routes/clinicalAssistant.js
+++ b/src/routes/clinicalAssistant.js
@@ -66,6 +66,11 @@ function positiveInt(value, fallback) {
   return Number.isFinite(n) && n > 0 ? Math.floor(n) : fallback;
 }
 
+function prepareClinicalImagePrompt(value) {
+  var prompt = String(value || '').replace(/\\?\[(?:\^?\d+(?:\s*,\s*\^?\d+)*)\\?\]/g, '').trim().slice(0, 4600);
+  return prompt + '\n\nDo not include citations, reference numbers, footnotes, source lists, named organizations, or invented references.';
+}
+
 if (process.env.CLINICAL_ASSISTANT_MCP_WARMUP !== 'false') {
   setTimeout(function() {
     warmMcpSession().catch(function(e) {
@@ -287,7 +292,7 @@ router.post('/clinical-assistant/image', async function(req, res) {
   try {
     var prompt = String(req.body.prompt || '').trim();
     if (!prompt) return res.status(400).json({ error: 'Prompt is required' });
-    if (prompt.length > 5000) prompt = prompt.substring(0, 5000);
+    prompt = prepareClinicalImagePrompt(prompt);
 
     var model = await getSetting('clinical_assistant.image_model', '') || process.env.CLINICAL_ASSISTANT_IMAGE_MODEL || 'openai-gpt-image-1';
     var image = await generateImage(prompt, model);
@@ -303,7 +308,7 @@ router.post('/clinical-assistant/image/jobs', async function(req, res) {
   try {
     var prompt = String(req.body.prompt || '').trim();
     if (!prompt) return res.status(400).json({ error: 'Prompt is required' });
-    if (prompt.length > 5000) prompt = prompt.substring(0, 5000);
+    prompt = prepareClinicalImagePrompt(prompt);
 
     var model = await getSetting('clinical_assistant.image_model', '') || process.env.CLINICAL_ASSISTANT_IMAGE_MODEL || 'openai-gpt-image-1';
     var id = crypto.randomBytes(16).toString('hex');
diff --git a/test/assistant-image-intent.test.js b/test/assistant-image-intent.test.js
index e61bae4e..7011f47a 100644
--- a/test/assistant-image-intent.test.js
+++ b/test/assistant-image-intent.test.js
@@ -13,6 +13,13 @@ test('assistant image intent does not intercept table retrieval requests', async
   assert.equal(isImageRequest('show me Table 13.1'), false);
 });
 
+test('clinical image prompts strip normal, escaped, and footnote citations', async () => {
+  const { buildContextualImagePrompt } = await imagesModule();
+  const prompt = buildContextualImagePrompt('Create a teaching visual', 'Claim [1], escaped \\[2, 3\\], and footnote [^4].');
+  assert.doesNotMatch(prompt, /\[1\]|\\\[2, 3\\\]|\[\^4\]/);
+  assert.match(prompt, /Do not include citations/);
+});
+
 test('assistant image intent still handles explicit visual requests', async () => {
   const { isImageRequest } = await imagesModule();
   assert.equal(isImageRequest('show me the diagram'), true);