There's not an easy, built-in way to do this. There is no rich text class or method to handle imported images -- only attached images.
You can use third-party tools to do this, such as Midas rich text API from Geniisoft. It can be done with the Notes C API, though deciphering the rich text "CD" records is a sort of a black art. Or, if you can do a little custom programming, use the NotesDXLExporter class to get an XML description of the document, use the XML manipulation classes to scan it for "picture" tags, and convert the encoded data back to binary, writing this data to a file. I don't have sample code on hand, but depending how you intend to deploy it and how much your time is worth, it's probably more cost effective to use Midas.
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This was first published in October 2004