Why won't my dentist give me copies of my digital x-rays?

October 24, 2007 10:47 AM

Can anyone think of a good reason why my dentist can't (won't) provide me with copies of the digital radiographs of my teeth? They say they can provide copies, but I've seen what copies of their digital pix look like and they're awful. The digital pix are just files on a laptop - why can't they copy them to a flash card? I even offered to provide the card. You would think paying $3,000.00 worth of dental work would be enough to cover copies of digital pictures? I don't want to cause problems with my dentist as he is my son's dentist as well and don't want to rock the boat unless it's absolutely necessary. So, I thought maybe a MeFite might have a logical explanation that I'm just missing. Thanks!
posted by Gerard Sorme to health (37 comments total)

I don't have an answer to why you can't get copies, but I do know that medical imaging devices often use a DICOM format that you can't read with common image viewers.
posted by demiurge at 10:49 AM on October 24, 2007

Could the original resolution be so huge as to be impractical to give to someone, or in a format only readable by expensive medical equipment?
posted by agregoli at 10:49 AM on October 24, 2007

your computer won't be able to read the format. but they should still humor you if you insist.. why not?

fax them a request, maybe?
posted by Izzmeister at 10:55 AM on October 24, 2007

I suppose it could be something regarding the format. He was looking at them on an HP laptop, so it doesn't need expensive equipment, but demiurge's comment about the DICOM format could be the answer. But still, you would have thought that in the letter rejecting my request that would have been explained. But, it very well may be the logic in their decision. I just assumed they were high-res Tiffs or Jpegs.
posted by Gerard Sorme at 10:56 AM on October 24, 2007

tell them you need the digital image for a second opinion about something... (as the other doc would be able to read the image)
posted by Izzmeister at 10:56 AM on October 24, 2007

Izzmeister...Actually that is exactly why I wanted them. I'm wondering if that's also exactly the reason they don't want to give them to me. You should see the quality of the copies - HORRIBLE!
posted by Gerard Sorme at 10:59 AM on October 24, 2007

It's worth noting that there are many free DICOM viewers for Windows.
posted by CrayDrygu at 11:03 AM on October 24, 2007

In California there's a statutory right to medical records. Here's an overview of the law.
posted by ClaudiaCenter at 11:03 AM on October 24, 2007

Yeah, if you are really that interested, it's no big deal for you to view DICOM images, it just takes a little work getting some software.

By quality, do you mean the images you saw on the laptop were noisy?
posted by demiurge at 11:06 AM on October 24, 2007

CrayDrygu, thanks for the info on DICOM viewing software.

demiurge, no, the quality of the digital images on the laptop were extraordinary! It's the paper copies they are "letting" me have that are awful. That's why I sent them the letter asking for copies of the digital images - which they rejected.
posted by Gerard Sorme at 11:10 AM on October 24, 2007

The answer is very possibly: "Because the dentist is computer illiterate and doesn't know how to copy the files properly."

My father's a dentist who does "technology"-based lectures to other dentists, and they really aren't very up-to-speed, on the whole.
posted by jozxyqk at 11:13 AM on October 24, 2007

Older thread with lots of info.
posted by GeekAnimator at 11:16 AM on October 24, 2007

I'd assume that it's the same reason why a professional photographer won't give u the RAW files from his camera.

They're his IP even though they aren't pictures of himself.
posted by mphuie at 11:35 AM on October 24, 2007 [1 favorite]

if you want them for a second opinion, have the new dentist you're going to call/write and request them, just like you would have other doctors do so to get your file.
posted by misanthropicsarah at 11:39 AM on October 24, 2007

He might not want to give them to you because he did work on you which a clear copy of the X-rays would show to have been unnecessary, or even contraindicated.
posted by jamjam at 11:48 AM on October 24, 2007

I don't think IP rights apply to medical records.

I think jamjam has it: He doesn't want you to have them because he's in ur mouth, steelin ur dollaz.
posted by Doohickie at 11:53 AM on October 24, 2007 [1 favorite]

(Which has happened to me in the past.)
posted by Doohickie at 11:53 AM on October 24, 2007

mphuie: "They're his IP even though they aren't pictures of himself."

Wrong. Medical professionals are covered by laws and regulations that photographers are not.

According to HIPAA, your doctor owns the physical media (the X-ray film itself), but you have rights to the image or data on it. In this instance, since there is no "physical media" to speak of, this really just means that you have every right to a copy of the DICOM files.

I would also argue that lower-resolution printouts of the DICOM data are not sufficient, as they have had significant quantities of useful information removed from them. They are, therefore, not actually copies of the medical data in your file.
posted by CrayDrygu at 11:54 AM on October 24, 2007 [2 favorites]

This is all very good information. Thanks to you all!
posted by Gerard Sorme at 11:58 AM on October 24, 2007

I suspect it's because the dentist and/or his staff know just enough about the equipment to make it work in day-to-day operation. They probably don't have a clue how to find the files, copy them off, etc. And like most people who have just a little bit of knowledge, they are probably terrified of doing something that will make the machine lose its magic smoke and leave them with a very expensive paperweight.

I suspect whenever they got the system, they were "trained" on how to use it in a very rote fashion; e.g. "do this, then this, and this will happen." And a lot of "do not ever do anything else."

Can you contact the manufacturer of the equipment/system and find instructions that you can print out and bring to them, which show how to copy images to external media?
posted by Kadin2048 at 12:05 PM on October 24, 2007 [1 favorite]

The animal hospital I work at has a digital x-ray machine that generates DICOM images. When we copy x-rays for clients or other doctors the software we use automatically includes a "Lite" version of itself on the CD to enable easy viewing.
posted by Rock Steady at 12:08 PM on October 24, 2007

Hmm. I bet Kadin2048 is right. It is not a very intuitive process to produce a CD of the images from our software, but as a referral and emergency practice we do it all the time, so we are used to it. If you find out what software they use, let me know, on the off chance it is the same one we use. If it is I can walk you (or them) through the procedure via email.
posted by Rock Steady at 12:13 PM on October 24, 2007

I've found some more useful info for you.

Here's a sample HIPAA request letter you can use, which has a polite-but-firm tone and reminds the doctor of his HIPAA obligations.

Also, here are the exact parts of the law that you may wish to reference. I have omitted some parts that I do not believe affect your request. The full text is available online.

§164.524(c)

(1) Providing the access requested. The covered entity must provide the access requested by individuals, including inspection or obtaining a copy, or both, of the protected health information about them in designated record sets. (...)

(2) Form of access requested. (i) The covered entity must provide the individual with access to the protected health information in the form or format requested by the individual, if it is readily producible in such form or format (...)

posted by CrayDrygu at 12:20 PM on October 24, 2007

Is it a question of wanting the actual files for later reference, e.g. showing to a different dentist, or just the curiosity of wanting to be able to look at the images of your body? Because when I asked about getting copies of x-rays of my chest they said it would cost like £36 per copy or something, so I ended up just taking digital photos of the x-rays while holding them up against a window for light. If you're just curious, maybe you could take photos of the laptop screen? With a half-decent camera you should get an OK image.
posted by EndsOfInvention at 12:30 PM on October 24, 2007

The answer is very possibly: "Because the dentist is computer illiterate and doesn't know how to copy the files properly."

Well.. More like they don't want to know how, because not knowing how is a good reason to not do it.
posted by Chuckles at 12:34 PM on October 24, 2007

FYI--many digital x-rays from dental offices are poor quality. I learned this when my dentist in Florida sent them to my (new) dentist in California. My new dentist was quite impressed by the quality of the digital films my old dentist sent. He said it's rare to see that kind of quality.
posted by 6:1 at 12:51 PM on October 24, 2007

I have recently heard stories of dentists performing unnecessary procedures…maybe this happened to you.
posted by doorsfan at 1:33 PM on October 24, 2007

Here's a blog article that I wrote about this very topic.
posted by plinth at 2:19 PM on October 24, 2007

No, I don't want them just to look at them. As I stated above, I want it for another dentist. Frankly, I have a colleague who had an excellent experience with a dentist in Mexico (huge industry - medical/dental tourism) and his $21,000.00 of work quoted in the US cost him $8,500.00 in Mexico. Great dentist, work is just as good as dentist here. But, that doctor requests not just COPIES of digital radiography, but the actual digital images because of poor quality of paper copies and the ability to zoom, isolate, etc.

It sounds like to me that the HIPAA "Form Of Request" posted a few posts above by CrayDrygu would allow for copies in the original digital format.

Thanks again for all the great replies!
posted by Gerard Sorme at 2:20 PM on October 24, 2007

If the images do happen to be in DICOM format, Irfanview (Windows only) can almost certainly handle the files (you need the plugin download as well as the main program).
posted by fief at 3:09 PM on October 24, 2007

Yeah, when medical information about a patient is generated, at least here in the U.S., the patient generally owns that information. Offices can charge a nominal fee for the time and materials required to duplicate those records, but they can't charge a very high fee for that, and they certainly can't withhold copies of your medical information from you.

DICOM is a proprietary format used for most xrays, true, but a blind bat could figure out how to work the free "Lite" image viewer on any Windows machine.

When you have "work done" in Mexico instead of the U.S., you're giving up some of the strongest malpractice protections that have ever existed. More here.
posted by ikkyu2 at 3:24 PM on October 24, 2007

If you can swing it, maybe you can have the dentist show the pictures on the PC, then take a PHOTO of the x-rays yourself with your own digital camera.
posted by fe2dell at 4:00 PM on October 24, 2007

I was dealing with a New York dental practice that was refusing to send me my records until I paid an exorbitant sum of money. Although my access to copies of the records was "guaranteed" under HIPAA, it was the State law that fixed the several-orders-of magnitude-lower maximum fees they were allowed to charge for these records. And although you can quote Federal law all you like, because of their proximity it's State law that's more likely to produce results. I was getting nowhere, literally, after several letters and phone calls, until I contacted the New York's Office of Professional Medical Conduct, and CC'd the annoying dentist. My records arrived within three days. Your State may have a similar process for recalcitrants.
posted by meehawl at 6:12 PM on October 24, 2007 [1 favorite]

[comment removed - a questions about xrays needs to not turn into a debate about malpractice laws. please take that discussion to metatalk]
posted by jessamyn at 9:53 PM on October 24, 2007

Same thing happened to me last week. The office did everything they could to insist I didn't need them, then printed copies on plain paper that you were lucky to find a tooth on; when I complained, they printed them on photo paper, and they were still so crappy the other dentist shot new ones. They just deliberately printed them low res in the end.

They assume the only reason you want them is for a second opinion, and they are in your mouth, doing whatever they damn feel like, and charging whatever they think they can get away with, and do not want you to ask someone who knows about these things. (That is my-dentist-specific, YDMV.)

Ortho X rays from the hospital were different. They burned them to a CD with the software to read them, and asked if this afternoon would be soon enough.
posted by unrepentanthippie at 5:47 AM on October 25, 2007

I think the comments saying that they're just technologically inept are spot on. We'd get copies of digital xrays from referring dentists that were literally just a photocopy on plain paper. Absolutely useless.
posted by Ruki at 11:04 AM on October 25, 2007

I'd assume that it's the same reason why a professional photographer won't give u the RAW files from his camera.

They're his IP even though they aren't pictures of himself.

If you hire a photographer, and you don't agree otherwise, the IP is yours, not the photographer's.
posted by oaf at 12:01 PM on October 25, 2007