tl;dr: In Germany, the images are health data, not art, copyright does not apply, All health data belongs to the patient. Medical personal involved in the crea

tl;dr: In Germany, the images are health data, not art, copyright does not apply, All health data belongs to the patient. Medical personal involved in the creation is authorized by the patient and bound by medical secrecy. I believe, in Germany, the images are not considered pieces of art to which copyright would apply. They are rather defined as patient's health information which is very rigorously protected by law, especially, but not only, by General Data Protection Regulation. The patient authorizes the doctor to create the images (a written consent that is secured during patient admission). All medical data, including the images, are object to medical secrecy! They are typically not even accessible for the health insurance - a clearing organisation ("Medizinischer Dienst") will resolve disputes between insurance and medical provider in an anonymized way. Any use of medical data for research, publication etc, needs to be authorized by the patient and anonymized. Any transfer of medical data from one medical provider to another (for example between hospital and GP) needs to be authorized. There are clear legal rules, how long the technical creator has to keep the data and who is allowed to access them for which purpose. Violation of medical secrecy is defined as felony and penalized accordingly under criminal law (copyright violations, in contrast, are considered delicts under civil law). The strict laws about medical secrecy are one of the major difficulties for digitalization of the German Health System. Any software that deals with medical data of any sorts is legally defined as "medical product", which has to apply to strict rules of security, secrecy and quality management. Failing this rules as a software developer/company or service provider can have severe legal consequences. Critical components - for example for the electronic exchange of medical data between providers of medical services - are therefore developed on a federal level with large complexity and endless delays. In any case, the patient is the sole owner of the data and can request it at any time from the medical provider. The handover might come with a fee, especially if the data has to be prepared in an elaborate way - like the production of Dicom-CDs or the like and this depends on the contract with the health insurance company. The patient is not paying for the data or the creation of it, though, but for the effort of the handover (could even be postage).