According to some examples, a method for Optical Coherence Tomography (OCT) image modification includes receiving an OCT image of a region of interest of patient tissue from an OCT imaging system configured to direct an OCT beam at the region of interest and determining that an OCT transparent instrument is within the OCT image. The method further includes detecting an artifact in the OCT image, the artifact resulting from the OCT transparent instrument being within a path of the OCT beam. In response to detecting the artifact, the method further includes creating an image modification plan to remove the artifact from the OCT image. The method further includes executing the image modification plan to remove the artifact from the OCT image.