An increased number of healthcare providers across the continuum of care share responsibility for providing treatment and care to the patient. Treatment is often provided at community-based facilities and not necessarily at the hospital that performed the imaging. As a result, there is an increased dependency on readily available access to a patient’s longitudinal imaging records. The ways in which diagnostic images and results are exchanged among providers within a patient’s circle of care have expanded. This article explores three varieties of image exchange. First, we examine image exchange patterns within a regional Diagnostic Imaging Repository and identify missed sharing opportunities. Secondly, we explore the use of a regional clinical viewer widely used in southwestern Ontario, called ClinicalConnect™, and examine the adoption of the viewer by providers. Finally, the paper provides a high-level look at how patients can leverage patient portals to view their imaging data to empower their healthcare experience.