Application of the Records management code of practice to radiology record retention protocols
Date: 2025
In 2021 NHSX published a revision to the Records management code of practice for health and social care (‘the Code’), which sets out what people working both with and in NHS organisations in England need to do to manage records correctly.1
At its core are a set of criteria that define the minimum retention period for ‘general health records’ (radiology images and reports).
While the guidance below may be of value to organisations elsewhere in the UK, or indeed the world, the specific legal framework of each individual country will always have primacy.
Should records be kept forever?
Primarily due to space and cost reasons, physical records (eg, X-rays, paper notes) have in the past been relocated off-site or disposed of entirely after an often arbitrarily defined time period. Similar pressures also apply to digital records, along with energy costs for keeping storage running. Furthermore, record migration to new radiology information system (RIS), picture archiving and communication systems (PACS) or vendor neutral archives solutions as suppliers are changed or hardware is upgraded is having increasing time and financial implications.
The UK General Data Protection Regulation (GDPR) states that information cannot be kept for ‘longer than is necessary’ but provides no specific details.2 For healthcare purposes, an imaging record is potentially useful many years after it was created, in which case its absence following deletion may be more harmful to the patient than keeping the record ‘just in case’. However, this argument has not been tested in an English court before now.
Storage costs, particularly for infrequently accessed historical data, can be reduced by the choice of storage location (in the cloud or an off-line repository) or data volume (compression or series rationalisation – the exclusion of duplicated series such as thin and thick slice reconstructions). Whatever the chosen method, all records must remain accessible for future clinical care (by ensuring the existence of a record is fully visible, that it can be retrieved in a clinically useful time frame and that it can be ‘read’ by any future system).
Radiology record retention requirements in the Code
The Code defines minimum retention periods for imaging of:
- Adults: 8 years from when the patient was last seen
- Children: until the child’s 25th birthday (or 26th birthday if 17 when last seen).
However, these default periods are subject to extension for many clinical indications (eg, cancer diagnosis, screening, chronic disease), each by varying amounts and from different start points.3 Further exceptions include potential use in a public inquiry, subject access request (SAR), Freedom of Information Act (FOIA) request, legal proceedings and coroner’s inquest.
A real-world approach
Currently, very few care providers impacted by the Code have the digital systems necessary to automatically and accurately identify all records that are subject to continued retention beyond the default period, nor do they have the staff resources available to complete this process manually.
In these circumstances and assuming that long-term record storage is in the best clinical interest of the patient, a simple retention period algorithm that meets all the requirements of the Code would be the latest of:
- 30 years from when the patient was last seen (anywhere in the organisation)
- 10 years after the death of the patient.
References
- NHSX. Records management code of practice for health and social care 2021. London: NHS England, 2021. www.gov.uk/government/publications/records-management-code-of-practice-for-health-and-social-care.
- Data Protection Act 2018. www.legislation.gov.uk/ukpga/2018/12/contents.
- The Royal College of Radiologists. Statement on the retention of oncology records (amended November 2023). www.rcr.ac.uk/news-policy/latest-updates/statement-on-the-retention-of-oncology-records-amended-november-2023.
Please find below, a link to the full guidance document.