Medical imaging has kept up with the digital age. Medical images such as x-rays are no longer keep on film or; even made with film. Rather, they are digital. In addition, they are transmitted for reasons of consultation and telehealth as well as archived. Transmission and retrieval of these images presents an integrity issue, with a high level of integrity being needed. Very small artifacts in a digital medical image can have significant importance, making or changing a diagnosis. It is imperative that the integrity of a medical image, especially in a Region of Interest be identifiable and preserved. Watermarking and steganography are used for the purposes of authenticating images, especially for copyright purposes. These techniques can be applied to medical images. However, these techniques can interfere with the integrity of the picture. While such distortion may be acceptable in other domains, in the medical domain this distortion is not acceptable. High accuracy is imperative for diagnosis. This paper discusses the techniques used, their advantages and shortcomings as well as methods of overcoming obstacles to integrity.