Quick Summary
CDs still exist, portals create new silos, and PACS fragmentation breaks continuity. The result is delayed care, repeat scans, and weaker AI because longitudinal imaging context is missing. Fixing imaging requires standards based sharing, provenance, and patient centered portability.
CDs never really went away
In many settings, CDs are still used to transfer imaging studies. They are fragile, easy to lose, and often incompatible with modern systems. They create delays in care and force rework when prior images cannot be accessed in time.
The persistence of CDs is a symptom of deeper interoperability gaps.
Portals create silos, not continuity
Many imaging providers offer portals. In practice, portals often create new silos. Each provider has its own login, viewer, permissions, and retention policies. Clinicians must context switch. Patients must remember where their data lives.
Access exists, but continuity does not.
PACS fragmentation is the core issue
PACS were designed for internal workflows, not cross institutional sharing. Hospitals often run multiple PACS. Labs and imaging centers run separate ones. Mergers add complexity. Vendors vary. Standards are unevenly implemented.
As a result, imaging histories are fragmented across systems that do not speak fluently to each other.
AI needs context, not just pixels
AI models for imaging often assume access to complete prior studies. In practice, that context is missing. Without longitudinal imaging history, progression and regression are harder to detect and clinical trust suffers.
Imaging AI is limited not by algorithms, but by data continuity.
The patient pays the price
When imaging history is fragmented, patients repeat scans. Costs rise. Diagnosis slows. Patients become couriers of their own data, carrying disks and links between systems that should already be connected.
What needs to change
- Standards based sharing that works across institutions
- Longitudinal organization across time
- Provenance and access control
- Patient centered portability
Imaging data is too important to remain trapped. Continuity is the missing layer.
Sources and further reading
- DICOM Standard (official site)
- RSNA: Imaging informatics resources
- ONC: Interoperability overview (why continuity matters)
Information only. Not medical advice.
Next steps
- Make imaging portable across institutions, not trapped in portals.
- Organize imaging longitudinally so change over time is visible.
- Ground AI outputs in full context, not isolated studies.