diff --git a/anatomy/templates/anatomy/question_detail.html b/anatomy/templates/anatomy/question_detail.html
index 5b74889f..a471602e 100644
--- a/anatomy/templates/anatomy/question_detail.html
+++ b/anatomy/templates/anatomy/question_detail.html
@@ -10,6 +10,12 @@
                 <div class="card-body">
                     <div id="anatomy-dicom-image" class="dicom-image-legacy w-100" data-url="{{ question.get_image_url }}" data-annotations='{{question.image_annotations}}' data-edit_annotation=true style="min-height:300px">
                     </div>
+                    {% if not question.image_annotations %}
+                        <div class="alert alert-warning mt-3" role="alert">
+                            <strong>No image annotations defined.</strong>
+                            <div class="small">If important markers or arrows are not burned onto the image, please add annotations using the image annotation tool and click <em>Save Annotations</em>. Please note not all questions required image annotations.</div>
+                        </div>
+                    {% endif %}
                     <div class="mt-3 d-flex justify-content-between align-items-start">
                         <details class="mb-0 flex-grow-1 me-2">
                             <summary class="small text-muted"><i class="bi bi-info-circle"></i> Image annotation help</summary>