We acknowledge the existing issues with imaging reports and recognize the importance of improving access for patients and providers. We have considered splitting the diagnostic report into three profiles, as outlined in the notes here ( https://hackmd.io/A910efYVTfmvstytxfN0Vg?view ) and here ( https://hackmd.io/92OJ5a4jRaG634NQnQ81JA?view ).   The Argonaut SMART Imaging Access  project is currently underway and is addressing many of the concerns raised by the commenter. The outcomes of this project may inform future updates to US Core. Thus, while we recognize the need for improvements in accessing imaging reports, a more cautious and considered approach is necessary at this time. To address the concerns raised, we will update guidance for accessing imaging studies in the US Core DiagnosticReport Profile for Report and Note Exchange Profile-specific implementation guidance: From Diagnostic imaging results in visual images requiring interpretation and clinical test results/reports may also reference images as part of the report. The DiagnosticReport resource links to both  Media  which represents a specific kind of Observation whose value is image data and  ImagingStudy  which represents the content in a DICOM imaging study. Only Media is marked as must support in this profile The imagingStudy element  MAY  be used by systems to reference ImagingStudy. However, it is not supported by the majority of systems and its inclusion would be an unnecessary barrier to adoption. To Diagnostic imaging results in visual images requiring interpretation and clinical test results/reports may also reference images as part of the report. There is no single approach for accessing imaging studies alongside clinical data using a single authorization flow to give patients and providers better access the images. The 'media.link' element is marked as must support, and the Media resource to   which it links can support a variety of patient-friendly content such as jpg images of xrays.  (see the DiagnosticReport Chest Xray Report Example) The optional 'imagingStudy' element  references DICOM study instance , s eries, and SOP instances  UUID   encoded in the ImagingStudy resource as identifiers. It MAY be used by systems with the right tools and specific viewers for their providers. Alternatively, systems can use business identifiers such as accession numbers in the 'identifer'  element to access the source images from external sources. However, it is not supported by the majority of systems and its inclusion would be an unnecessary barrier to adoption.