Do individuals have a right under HIPAA to get copies of their x-rays or other diagnostic images, and if so, in what format?

Yes. An individual has a right to receive PHI about the individual maintained by a covered entity in a designated record set, such as a medical record. See 45 CFR 164.524(a)(1). This includes x-rays or other images in the record. As with other PHI in a designated record set, the individual has a right to access the information in the form and format she requests, as long as the covered entity can readily produce it in that form and format. See 45 CFR 164.524(c). The large file size of some x-rays or other images may impact the mechanism for access (e.g., the format agreed upon by the individual and the covered entity must accommodate the file size).