This report outlines methods for the secure electronic exchange and utilization of electronic digital image files, including those requiring diagnostic quality. Such images may include diagnostic radiographs, intraoral and extra-oral photographs, video, optical impressions and oral pathology photomicrographs. Caution is advised against the utilization of unsecure exchange transmission modes, such as unencrypted e-mail attachments sent over the Internet or any other unsecured electronic exchange not conforming to accepted security transmission standards. Secure electronic exchange can be utilized for a variety of purposes, such as storage of archived data in a location physically separated from the practice, distance consultation, fabrication of image-based appliances or for financial and other administrative purposes. Currently available practices and existing constraints to diagnostic image exchange are reviewed and potential solutions offered. The purpose of this report is to outline the means of secure electronic exchange of diagnostic quality digital radiographs, photographic images and other imaging modalities used in dentistry.