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Patient access to medical images has become a defining issue for healthcare organizations as imaging volumes grow and care increasingly spans multiple providers and facilities. Diagnostic images such as X-rays, CT scans, MRIs, and ultrasounds are central to how clinicians manage a patient’s course of treatment, yet the methods used to get those images into patients’ hands, and into the hands of the next provider, vary widely across the industry [1]. For healthcare administrators, imaging leaders, and IT leaders, the choice of image access method is not simply a technology decision. It affects patient experience, administrative workload, interoperability with outside providers, and the pace at which a patient can move from one point of care to the next.
This comparison examines the three approaches most commonly used to give patients access to their medical images: patient portals, secure links or digital image-sharing platforms, and physical disks or CDs. Each method has a distinct history, set of operational tradeoffs, and role in the broader shift toward connected, digital health information exchange. No single method is universally correct for every organization, and the right mix often depends on patient population, technical infrastructure, referral patterns, and regulatory obligations.
Radiology has become a focal point for patient engagement policy because imaging results and images are now more available electronically than at almost any point in the past [2]. Federal policy has accelerated this shift. The 21st Century Cures Act made the electronic sharing of health information the expected norm in healthcare and directed regulators to define the conditions under which withholding that information would constitute information blocking [3]. Practices that unreasonably interfere with a patient’s or provider’s access to electronic health information, including imaging, can be evaluated under this framework and, for certain actors, can carry financial consequences [3].
Beyond regulatory obligations, there is a clinical and experiential case for timely image access. Patients who can review their own reports and images tend to report improved satisfaction, a reduced chance that results go unnoticed, and better preparation for follow-up conversations with their care teams [2]. A systematic review cited in recent portal research also links patient portal use to improved monitoring of health status and better-quality patient-provider interactions [2]. At the same time, when images are not readily accessible to outside providers, patients and caregivers are frequently left responsible for physically transporting studies between organizations, which can introduce delay, cost, and clinical risk [1].
A patient portal is a secure, authenticated web or mobile application tied to a patient’s electronic health record (EHR) that allows the patient to log in and view clinical information, including, where enabled, radiology reports and images [4]. Image-enabled portals typically connect the patient-facing application to the organization’s picture archiving and communication system (PACS) or vendor neutral archive (VNA) so that a patient can launch a dedicated image viewer directly from their result or from a link inside the portal [2]. Some organizations layer additional functionality on top of viewing, such as the ability to download a study or share it with another provider through the same authenticated session [2].
Adoption of this capability has grown substantially over the past decade. As of 2021, roughly 96 percent of non-federal acute care hospitals in the United States enabled patients to view health information in a portal, and 92 percent enabled patients to download that information, though rates were measurably lower among small, rural, and independent hospitals [5]. Image-specific functionality has not kept pace with general portal adoption. One large pediatric hospital reported that in the first 90 days after enabling image viewing in its portal, patients viewed 22 percent of the imaging studies performed in the department [4]. A separate multi-year study at an academic medical center found that 25.5 percent of exam images were viewed by patients through the portal, with viewing rates highest for MRI and PET studies at 40.1 percent and lower for other modalities [2].
Portals give patients a single, recurring destination for their health information rather than a one-time transaction, which supports repeat engagement with results over time [2]. Because portals are tied to the patient’s broader medical record, they also make it possible to view a report alongside the associated images and other clinical context in one place [4]. Device flexibility is a notable strength: in one study, 72.8 percent of image views occurred on smartphones, compared with 25.8 percent on desktop computers and 1.4 percent on tablets, indicating that portal-based image access accommodates how patients actually use technology day to day [2]. Portals can also be configured to support shared or proxy access, which allows family members or caregivers to be involved in a patient’s care when appropriate [2].
Portal-based image viewing has not seen the same utilization as portal-based report viewing. In the same study, 54.1 percent of reports were viewed compared with only 25.5 percent of images, suggesting that many patients either do not notice the image-viewing feature or do not feel equipped to interpret what they see [2]. Engagement also varies by demographic factors: patients aged 18 to 39 viewed 64 percent of their reports, while patients aged 80 and older viewed only 34 percent, a gap the researchers attribute in part to differences in computer or smartphone literacy among older patients [2]. Reports were also viewed more frequently by patients whose preferred language was English (57.1 percent) than by patients who preferred another language (33.3 percent), which points to language access as a factor organizations should address when designing portal experiences [2].
From an operational standpoint, image-enabling a portal requires integration between the EHR-based portal, the universal viewer, and the underlying archive, along with attention to embargo policies that govern when a result becomes visible to the patient [2]. Radiologists surveyed about the practice generally reported no meaningful change to their workflow and few direct patient contacts as a result of portal access, and separate research found that access to health information through a portal did not increase patient anxiety, which addresses two common concerns raised before implementation [2].
Secure links, sometimes delivered through dedicated image –exchange networks rather than the patient’s own portal, allow a patient or another care team to access a specific study through an authenticated, often time-limited, web-based connection rather than a portal login or physical media [6]. This category includes vendor neutral archive-based sharing tools, cloud image exchange networks, and standards-based exchange built on protocols such as DICOM, DICOM web, and Integrating the Healthcare Enterprise profiles for cross-enterprise document and image sharing [1]. One of the earliest large-scale efforts in this space, the Image Share Network, allowed participating radiology sites to share imaging records with patients through secure online accounts rather than CDs, and the Radiological Society of North America later developed a validation program to test vendor systems against the standards used in that network [6].
The primary advantage of secure link-based sharing is that it removes the dependency on physical media entirely while still giving patients or receiving providers a direct, controlled path to full-resolution images [6]. According to the Radiological Society of North America, secure image-sharing approaches can improve efficiency and quality of care by giving patients access to their images in a secure environment rather than on CDs, providing physicians a more complete diagnostic history for treatment decisions, and reducing unnecessary repeat exams when prior studies are readily accessible [6]. Reducing repeat imaging in this way has a direct bearing on patient radiation exposure and cost, since duplicate studies driven by inaccessible prior images add both [7].
Secure links are also well suited to time-sensitive care transitions, such as when a patient is being transferred between facilities, because the image can be made available as soon as it is captured rather than after a physical disk is burned and transported [8]. Standards-based approaches also create a path toward higher interoperability than static media, since the same infrastructure that supports a patient-facing secure link can, in principle, support provider-to-provider exchange [1].
Despite this promise, federal regulators have found that access to diagnostic images across organizational boundaries remains “nonexistent, inconsistent, and highly dependent on several technical, operational, and organizational factors,” even where secure electronic exchange is technically possible [1]. In some cases, organizations’ systems use proprietary formats that impede exchange, or external users are given access only to lower-resolution or encapsulated versions of a study rather than full-resolution DICOM files [1]. A 2025 request for information from federal health IT regulators identified a fragmented ecosystem in which diagnostic image exchange is often manual, burdensome, and unreliable, even when secure electronic methods exist alongside continued reliance on physical media [1]. As of early 2026, regulators had not finalized new certification requirements specific to imaging links, after a related 2024 proposed rule addressing image-link certification criteria was withdrawn in December 2025 [1]. This means organizations currently implementing secure link sharing are often doing so without a uniform national technical standard to follow, which can create inconsistent experiences across vendors and health systems [1].
Under the DICOM Part 10 standard, imaging studies can be written to removable media such as CDs or DVDs, typically bundled with a proprietary viewer application selected by the CD-burning vendor [8]. The patient or a courier then physically carries or mails the disk to the receiving facility, where staff load the images, most often by copying them into the local PACS rather than relying on the disk’s built-in viewer [8]. This method predates most digital exchange standards and became the default replacement for film once imaging departments adopted PACS in the late 1990s and early 2000s [8].
The operational burden of CD-based sharing is well documented. In interviews with 85 healthcare providers and staff across urban, suburban, and small-town practices, researchers found that subspecialists frequently experienced difficulty and delays accessing outside imaging studies delivered on portable media, and that these delays sometimes contributed to delayed diagnosis and treatment or to duplicate imaging studies [7]. Providers cited difficulty loading studies, unfamiliarity with proprietary viewer software bundled on each disk, and the time burden of manipulating images once loaded as recurring obstacles [7]. Because each CD-burning vendor uses its own approach to storing images, reports, and viewer software, no two disks are guaranteed to work the same way at the receiving end, and if a disk is damaged, some or all of the images on it may be unrecoverable [8].
Patients themselves are also a point of failure in this workflow: staff reported that patients sometimes forgot to bring requested CDs to appointments, and that reports, when present at all, were not always in a location or format clearly tied to the correct associated study [7]. It routinely took several days to weeks for physicians to receive CDs containing relevant studies from outside facilities, and requested studies were occasionally never received at all [7]. A more recent federal review reiterated that reliance on physical media such as CDs and DVDs remains “generally inefficient, not secure, and presents barriers to timely care,” and specifically flagged persistent CD reliance among many U.S. children’s hospitals despite the existence of electronic image-sharing platforms [1]. Because most modern computers no longer include optical drives, providing a patient with a CD in many cases still requires that patient to locate compatible hardware simply to open a disk intended for single-use physical transport [4].
Despite these documented limitations, physical disks have not disappeared from clinical practice. Primary care physicians in the same interview-based study relied primarily on written reports for most study types other than X-rays and did not report the same access difficulties as subspecialists, indicating that need for direct image access varies meaningfully by specialty [7]. CDs also remain a practical fallback in settings where a receiving provider’s system cannot ingest an electronic transmission, where organizational agreements for electronic exchange have not been established, or where a patient specifically requests a physical copy for their own records [1].
Category | Patient Portals | Secure Links / Digital Sharing | Physical Disks / CDs |
Ease of patient access | High once registered; requires a portal account and login [4]. | High; often accessible without a full portal account via a direct link [6]. | Low; requires physical pickup or mailing and compatible hardware [8]. |
Speed | Available as soon as embargo periods clear [2]. | Can be available immediately after capture [8]. | Delayed by burning, transport, and manual loading; often days to weeks between facilities [7]. |
Device accessibility | Strong on mobile; 72.8% of views were on smartphones in one study [2]. | Web-based and generally cross-device, though dependent on the receiving viewer [6]. | Requires an optical drive, increasingly uncommon on modern computers [4]. |
Interoperability with other providers | Limited to what the portal exposes to the patient; not a direct provider exchange channel [4]. | Designed for cross-organization exchange; standards-based approaches support this goal, though real-world implementation is inconsistent [1]. | Physical transport only; no electronic exchange with other systems [8]. |
Administrative burden | Requires integration and embargo management, but scales without per-patient manual effort [2]. | Requires standards-based infrastructure but reduces per-request manual handling once implemented [1]. | High; manual burning, tracking, and loading for every request [7]. |
Security and privacy | Authenticated patient login tied to identity verification [4]. | Authenticated, often time-limited access controls [6]. | Physical media can be lost, damaged, or misplaced by the patient [8]. |
Scalability | Scales across a large patient population once implemented [5]. | Scales across organizations when standards-based exchange is adopted [1]. | Does not scale efficiently; each disk is a discrete, manual transaction [8]. |
Risk of care delay | Low once the patient is registered and comfortable with the portal [2]. | Low when the receiving system can accept the link [6]. | Documented association with delayed diagnosis, treatment, and duplicate imaging [7]. |
No method in this comparison is free of tradeoffs. Portals depend on patient registration, digital literacy, and language accessibility, and image-specific engagement still lags behind report viewing [2]. Secure links depend on standards adoption and interoperability that remain inconsistent across vendors and organizations even where regulators are actively examining the issue [1]. Physical disks remain functional in narrow circumstances but carry the most consistently documented operational and care-delay risks of the three approaches [7].
Industry and federal attention has moved steadily toward reducing reliance on physical media in favor of connected, standards-based image access. A 2025 information-gathering effort from federal health IT regulators specifically asked stakeholders what would accelerate the shift from CDs and DVDs to secure, electronic exchange-based methods for sharing diagnostic images [1]. The same effort noted that continued reliance on physical media is a recognized barrier to timely care and that a lack of patient access to diagnostic images through modern, API-driven tools remains a documented gap in the current ecosystem [1].
At the same time, general patient portal capability has become close to universal among U.S. hospitals, with 96 percent enabling patients to view health information online as of 2021, though disparities persist for small, rural, and independent facilities [5]. This gap between broad portal availability and comparatively low image-specific viewing and cross-organization exchange rates suggests that the industry’s transition away from physical media is still underway rather than complete [2, 1]. Organizations evaluating their own approach to patient access to medical images are, in effect, navigating this same transition at an institutional level, weighing the maturity of their existing infrastructure, their patient population’s needs, and their referral network’s technical capabilities against the documented limitations of continuing to rely on CDs.
Selecting an approach, or a combination of approaches, to patient access to medical images depends on several organization-specific factors rather than a single best practice. Relevant considerations include the existing EHR and portal infrastructure already in place, since image-enabling a portal requires integration with the enterprise viewer and archive [2]. Patient population characteristics matter as well, since engagement with image viewing varies by age, language preference, and device access [2]. Referral and transfer patterns are also significant, since subspecialists and receiving facilities that frequently need outside imaging report more friction with physical media than primary care settings that rely mainly on written reports [7]. Finally, organizations must weigh current regulatory obligations under the information blocking framework, along with the likelihood of future certification requirements specific to diagnostic imaging exchange, when deciding how much to invest in secure link infrastructure now [3, 1].
How can patients access their medical images?
Patients typically access their medical images in one of three ways: through a patient portal tied to their electronic health record, through a secure digital link or image-sharing platform, or through a physical disk or CD provided by the imaging facility [4, 6, 8]. The method available to a given patient depends on the technology their care organization has implemented and, in some cases, on the specific request they make.
Can patients view medical images through a patient portal?
Yes, when a healthcare organization has image-enabled its portal by connecting it to the underlying picture archiving and communication system or vendor neutral archive [4]. Image viewing through portals has grown but still lags behind report viewing; one study found that only 25.5 percent of exam images were viewed by patients compared with 54.1 percent of reports [2].
What is a secure link for medical images?
A secure link is an authenticated, often time-limited web-based connection that allows a patient or another provider to access a specific imaging study without using a portal login or physical media [6]. These links are frequently built on standards such as DICOM, DICOM web, or IHE cross-enterprise document sharing profiles to support exchange across different organizations and systems [1].
Are CDs still used to share medical images?
Yes. Despite documented limitations, CDs remain in use, particularly where receiving systems cannot accept an electronic transmission or where organizational agreements for digital exchange have not been established [1]. Federal reviewers have specifically noted continued CD reliance among many U.S. children’s hospitals even where electronic image-sharing platforms exist [1].
What are the limitations of using CDs for medical images?
CDs require compatible hardware that is increasingly uncommon on modern computers, depend on proprietary viewer software that varies by vendor, and can be lost, damaged, or forgotten by the patient [8, 4]. Research based on interviews with healthcare providers found that CD-based sharing routinely took several days to weeks to reach the receiving physician and was associated with delays in diagnosis and treatment as well as duplicate imaging in some cases [7].
Can patients share their medical images with another healthcare provider?
Patients can share images with another provider through a portal’s sharing function where available, through a secure link generated by the originating facility, or by physically carrying a CD to the new provider [2, 6, 8]. Standards-based secure sharing is generally positioned as the more interoperable option for this purpose, though real-world implementation still varies across organizations [1].
What should healthcare organizations consider when choosing a patient image access method?
Organizations should weigh their existing portal and archive infrastructure, their patient population’s digital literacy and language needs, how frequently patients and providers need to exchange images with outside organizations, and current and anticipated regulatory requirements under the information blocking framework [2, 7, 3]. Many organizations use a combination of methods rather than relying on a single approach, particularly during the ongoing transition away from physical media [1].
Conclusion
Patient access to medical images spans a spectrum from patient portals to secure digital links to physical disks, and each method reflects a different stage in the industry’s broader move toward connected, digital health information exchange. Portals offer patients an integrated, mobile-friendly destination for their health information but still show relatively low engagement with image viewing specifically [2]. Secure links offer a path toward standards-based interoperability but remain inconsistently implemented across organizations and vendors [1]. Physical disks remain functional in narrow circumstances but carry the most extensively documented risk of administrative burden and care delay [7]. Healthcare organizations evaluating their approach to patient image access are best served by weighing these tradeoffs against their own infrastructure, patient population, and referral patterns rather than assuming any one method is appropriate for every setting.i
Works Cited
[1] Office of the National Coordinator for Health Information Technology. “Request for Information: Diagnostic Imaging Interoperability Standards and Certification.” Federal Register, 30 Jan. 2026, www.federalregister.gov/documents/2026/01/30/2026-01866/request-for-information-diagnostic-imaging-interoperability-standards-and-certification.
[2] Wang, Jason, et al. “Patterns of Access to Radiology Reports and Images Through a Patient Portal.” Journal of Digital Imaging, 2024, doi.org/10.1007/s10278-024-00996-0.
[3] Office of the National Coordinator for Health Information Technology. “Information Blocking.” HealthIT.gov, healthit.gov/information-blocking/.
[4] Dhamija, Akhil, et al. “Image-Enabling the Patient Portal of an Electronic Health Record.” Journal of Digital Imaging, vol. 34, no. 2, 2020, pp. 483-488, pmc.ncbi.nlm.nih.gov/articles/PMC8289980/.
[5] Office of the National Coordinator for Health Information Technology. “Hospital Capabilities to Enable Patient Electronic Access to Health Information, 2021.” HealthIT.gov, Oct. 2022, healthit.gov/data/data-briefs/hospital-capabilities-enable-patient-electronic-access-health-information-2021/.
[6] Radiological Society of North America. “Image Share Validation Program.” RSNA.org, www.rsna.org/practice-tools/data-tools-and-standards/image-share-validation-program.
[7] Ge, Yaorong, et al. “Insight into the Sharing of Medical Images.” Applied Clinical Informatics, vol. 3, no. 3, 2012, pp. 250-262, doi.org/10.4338/aci-2012-06-ra-0022.
[8] Vreeland, Amy, et al. “Considerations for Exchanging and Sharing Medical Images for Improved Collaboration and Patient Care: HIMSS-SIIM Collaborative White Paper.” Journal of Digital Imaging, vol. 29, 2016, pp. 547-558, doi.org/10.1007/s10278-016-9885-x.
i: Intended Use & Diagnostic Display Notice
The digital image distribution capabilities described in this article (including patient portals and secure web links) are intended strictly to facilitate secure access, secondary review, and informational reference of DICOM-compliant diagnostic imaging data across web and mobile endpoints.
Diagnostic Disclaimer: Diagnostic images displayed via standard consumer web browsers, non-DICOM-calibrated screens, or unvalidated mobile devices are not cleared for primary diagnostic interpretation. Primary diagnostic reading must be performed by qualified medical professionals using an FDA-cleared or CE-marked diagnostic display system.
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