I've made a couple of quilts with pictures. I've only used the sheets you put thru an injet printer (don't use a laser, it doens't work. trust me ugh, tee hee). Anyway... I've attached them to the top of the quilt with a satin stitch, and I've sewn them in like you would any other piece of fabric. Pretty simple to use. My only complaint... they don't shrink like the rest of your fabric when you wash it, so they pucker. Best thing I've found so far, is to add another layer of POLY batting under the picture, kinda like trapunto... to help it lay smooth.