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Background: Blockchain technology has better security and immutable features, which are beneficial for healthcare data management. Decentralisation data management allows better sharing of medical images between units and departments. Objectives: The objectives of this study were to determine the cost of adopting the blockchain-based system for medical images and the cost-benefit analysis for five years of adoption of this technology at a district hospital in Malaysia. Methodology: Data regarding the yearly costs and workload for 2016 until 2018 were collected from a district hospital in Malaysia. The cost of blockchain implementation was obtained from a company that developed this technology. The cost-benefit analysis was done using the capital budgeting method for five years of this technology adoption. Sensitivity analysis was done to assess uncertainty conditions during this adoption. Results: The total yearly cost of Radiology Unit for 2018 was MYR490,168.96. The cost for adopting blockchain technology was MYR80,000 for the software, MYR115,000 for upgrading the assets and yearly maintenance cost was MYR16,000. The total present value of net benefits for five years of technology adoption was MYR865,295.01. Sensitivity analysis shows that consumables cost-saving is the most sensitive variable. Most pessimistic situation analyses showed positive net benefits. Conclusion: The adoption of blockchain technology in managing medical images offers numerous benefits to public hospitals in Malaysia. Investment in this technology can provide a good return to the organisation. [ABSTRACT FROM AUTHOR]