When you have an X-ray, CT, MRI, or ultrasound, two separate records are created: the images themselves and the radiologist's report that interprets them. Your HIPAA right of access covers both. Patients often assume the images are somehow off-limits or that only a doctor can obtain them, and neither is true. You have the right to inspect and get a copy of this information in a designated record set, the same as any other part of your record.
Two different things: images and the report
The report is the written interpretation, findings, impression, and recommendations, and it is what most other clinicians rely on. The images are the actual scans, usually stored in a format called DICOM. If you are getting a second opinion, the new specialist frequently wants the images, not just the report, because they want to look for themselves. Decide which you need, or ask for both, so you are not surprised when a report arrives without the pictures.
Who actually holds your images
The most common point of confusion is where to send the request. The facility that performed the imaging, the hospital radiology department, the imaging center, is typically the custodian of both the images and the report, and it is usually the right place to ask. The physician who ordered the scan generally receives the report but may not hold the full-resolution images. If you are unsure, start with the imaging facility.
How to make the request
- Contact the imaging facility's medical records or release-of-information office, not the front desk that schedules scans.
- Specify what you want, the report, the images, or both, and the study dates.
- State the format you prefer, and if the record is electronic and you want an electronic copy, say so.
- Provide identification as the facility requires to verify you are the patient or an authorized representative.
- Ask about the timeline and any fee up front, so nothing is a surprise.
Formats, from CD to portal
Historically images were handed over on a CD or DVD in DICOM format with a small viewer included. That still happens, but many facilities now offer secure electronic delivery or a portal download. If the images are maintained electronically and you request an electronic copy, the facility must provide it in the electronic form and format you request if it is readily producible, and otherwise in a readable electronic form you both agree on. If you are taking images to another provider, ask what format that provider can accept so you request the right thing once.
Timeline and fees
The facility must act on your request no later than 30 days after receiving it, with one possible 30-day extension if it notifies you in writing of the reason within the original window. Any fee must be reasonable and cost-based, limited to things like the labor for copying, the media for an electronic copy or the supplies for a physical one, and postage if you asked for it to be mailed. Search-and-retrieval time is not a permitted charge. If a facility quotes a fee that looks more like a deterrent than a copying cost, that is worth questioning, because the right of access is not supposed to be priced out of reach.
Common questions
Can I get my own radiology images, not just the report?
Yes. Your HIPAA right of access under 45 CFR 164.524 covers both the radiologist's report and the images themselves when they are held in a designated record set. You do not need to be a physician or justify the request to obtain your own imaging.
Where do I request my imaging?
Usually from the facility that performed the imaging, the hospital radiology department or imaging center, which typically holds both the images and the report. The ordering physician often receives the report but may not hold the full-resolution images, so the imaging facility is the best starting point.
What format will I get my images in?
Images are commonly provided on a CD or DVD in DICOM format with a viewer, but many facilities now offer secure electronic delivery or a portal download. If the images are maintained electronically and you request an electronic copy, the facility must provide it in the electronic form and format requested if readily producible.
How much can I be charged for radiology records?
Only a reasonable, cost-based fee, limited to items like labor for copying, the electronic media or supplies for a physical copy, and postage if you asked for mailing. Search-and-retrieval time is not a permitted charge, and the facility must act on the request within 30 days, with one possible 30-day extension on written notice.