How to choose a teleradiology company: 2026 buyer's guide

Three names that would have anchored a teleradiology shortlist in 2023 no longer stand where they did, and each change is documented by a party to it. vRad's own practice timeline says it joined Radiology Partners in 2020. I-MED Radiology Network announced the acquisition of StatRad on 2 July 2024, in a release titled "I-MED Radiology acquires teleradiology provider, StatRad, and enters the US market". And ONRAD's about page records the acquisition of Direct Radiology in December 2024. All checked 10 August 2026. So choose a teleradiology company on the five things that survive a change of owner. Each one is something a vendor will put in writing: turnaround published by priority tier with a trailing compliance figure, radiologists licensed in the state where your patients are located and reading from inside the United States, subspecialty sections matched to your case mix, an all-in price with every fee named, and a measured discrepancy rate.

Buyers usually brace for a quality argument. Whose radiologists are stronger, whose panel is deeper, who reads the hard cases better. From the outside that argument is unwinnable, because every vendor sounds equally confident and none of them will hand you a stack of their own misses. What you can settle from the outside is whether the commitments are written down, measurable, and durable when the logo on the invoice changes. That is what the 25 questions below are for, along with the pricing models side by side and the red flags that should end a call.

Five answers to get in writing from any teleradiology company

The five answers worth getting in writing are turnaround with its clock defined, licensure where your patients are located, subspecialty match to your case mix, an all-in price, and a measured discrepancy rate. Marketing copy offers "industry-leading turnaround" and "trusted nationwide"; neither predicts what happens when a stroke protocol CT finishes at 2 a.m. and lands on a worklist.

1. Turnaround, with the clock defined. A median is only as honest as the clock behind it. Some vendors start counting when a radiologist opens the study, erasing every minute it sat unassigned in a queue. Others stop at a preliminary impression phoned down to the ED and never time the final signed report. Both choices flatter the median. AstraRad starts the clock when the last image of the study arrives and stops it when the radiologist signs the final report; the tiers, STAT under 1 hour, urgent under 4 hours, routine under 24 hours, are published on the SLA page. Get every vendor to state its clock in one sentence: two companies quoting the same number can be timing two different things.

2. Licensure in the state where your patients are. The interpreting radiologist must hold a license in the state where your patient is located, and the ACR practice standard goes further, expecting licensure where the study was performed and where it is read. Ask how quickly the vendor credentials for a new facility, and whether it uses the Interstate Medical Licensure Compact, which pulls a new state license down to weeks. Then ask where the radiologist physically sits at the moment of signature, because Medicare pays the professional component only for interpretations performed inside the United States. Every AstraRad radiologist reads from within the US and holds a license in the state where your patients are; the licensing hub covers the mechanics, and coverage by metro market describes what that looks like where you actually operate.

3. Subspecialty sections matched to your case mix. Pull your last 90 days of studies by modality and body part, then ask which named section reads each line of that table. A child's abdominal CT should reach a pediatric radiologist who reads children all day; a coronary CTA should reach a cardiac imager who reads coronaries every shift. AstraRad's panel of board-certified, fellowship-trained subspecialists covers neuro, MSK, body, cardiac, breast, pediatric, chest, ER, oncologic and nuclear imaging, and each case routes to the section trained for it. A vendor with depth names the section without checking.

4. Price, all in. Minimums, platform fees, integration fees, after-hours surcharges and priority multipliers all sit outside the number on the first slide, and any two of them can double an apparently low per-study rate. Ask for one figure: what a month of your actual mix costs, every fee included. The pricing section below compares the three common structures, and the teleradiology cost guide goes deeper on industry ranges by modality.

5. QA you can put a number on. Ask what share of signed reports get an independent second read, what the major discrepancy rate is, how a discrepancy gets defined, who adjudicates it, and what happens with the reader afterward. AstraRad double-reads 1 in 20 signed reports independently and holds major discrepancies under 0.3%; every one is reviewed at the monthly discrepancy meeting and closed with the radiologist who signed it. Peer review "as needed" means QA starts when somebody complains.

Skip the numbers that predict nothing: total radiologist headcount, countries served, media logos, and "years in business" claims that predate the current owner.

AstraRad answers its own checklist, line by line

AstraRad's answer to every item on that checklist is below, each published somewhere you can verify it.

Checklist item	AstraRad's answer
Median STAT turnaround	30 minutes, measured from last-image arrival to radiologist signature. See STAT reads at a 30-minute median
SLA tiers	STAT under 1 hour, urgent under 4 hours, routine under 24 hours, published on the SLA page
SLA compliance	99.4% of reports came back inside their tier over the trailing 12 months
Coverage	24/7/365, staffed on scheduled day, evening and overnight shifts, every radiologist reading from within the United States
Radiologists	240 board-certified, fellowship-trained subspecialists across neuro, MSK (musculoskeletal), body, cardiac, breast, pediatric, chest, ER, oncologic and nuclear imaging
Reads delivered	Final signed reports, chart-ready and billable on arrival
Licensing	Radiologists licensed in the state where your patients are located; details on the licensing hub
QA	1 in 20 signed reports independently double-read; major discrepancy rate under 0.3%
Capacity	Headroom for 25,000 additional studies per month; an 8,000-study backlog clears in under 30 days
Pricing	Per signed report only, priority multiplier printed on the rate card, nothing recurring billed beside it
Technology	DICOM from your PACS or portal upload, no integration project; HL7/FHIR report delivery
Compliance	HIPAA aligned under a signed BAA, EU imaging processed under a DPA, DICOM conformant; details on the compliance page
Ownership	Independent, with no private-equity roll-up owner and no acquisition to renegotiate around
Study types	CR X-ray, mammography, ultrasound, CT including coronary CTA, MRI including cardiac, nuclear medicine gamma, PET-CT

Run the same table against every vendor on your shortlist. The filled cells are the comparison.

Where AstraRad is the wrong choice

AstraRad is the wrong choice if you need a radiologist in the building, if you want the lowest unit rate on flat, high volume, if you want cheap preliminaries and can overread them in the morning, or if your scorecard is emergent protocol speed at national scale or a certification stack.

A radiologist in the building. Fluoroscopy, image-guided biopsies, contrast reaction coverage, a tumor board where the radiologist is in the room: none of that travels over a wire. AstraRad reads studies and signs reports. Staffing a department is a different purchase, and the in-house vs outsourced comparison walks through where the line usually falls.

The lowest unit rate on high, flat volume. A committed-minimum contract buys a lower headline rate in exchange for a spend floor, and if your volume genuinely never dips, that structure wins on unit cost. Per-report pricing with no minimums is built for volume that moves.

Cheap preliminaries with morning overread capacity. A prelim-only nighthawk quotes below a final signed report, because a preliminary impression is a smaller product with a smaller liability attached. AstraRad signs finals only. If your morning schedule has room to re-read everything from the night, a prelim vendor will look cheaper on the invoice.

Emergent protocol speed at national scale, or a certificate on the wall. Two competitors beat us outright on axes this checklist takes seriously, and a guide that never says so is a brochure. vRad publishes stroke protocol turnaround under 7 minutes on average and trauma under 12 minutes on average on its critical care page, alongside over 250 certified stroke centers served and more than 130,000 stroke studies interpreted annually. No small panel reproduces that density, and a stroke center graded on door-to-interpretation should weigh it. StatRad publishes ISO 27001:2022 and ISO 13485:2016 certification and FDA 510(k) clearance as a registered medical device manufacturer on its services page. AstraRad holds no SOC 2 report, no ISO 27001 certificate, no HITRUST certification and no Joint Commission accreditation, and claims none, so a procurement screen built on certificates is one we fail. Both checked 10 August 2026.

Send these 25 questions to every teleradiology company you shortlist

Send all 25 questions and require written answers; a vague response is itself data.

Turnaround and coverage

1. What is your median STAT turnaround, measured from last-image arrival to radiologist signature?
2. What are your contractual SLA tiers for STAT, urgent, and routine studies?
3. What was your SLA compliance over the trailing 12 months, and will you report it monthly?
4. Is coverage continuous 24/7/365, including holidays, and how is overnight staffing structured?
5. How much spare capacity do you hold for volume spikes, and what happens to turnaround during flu season or a backlog handoff?

Licensing and credentialing

6. Are all interpreting radiologists licensed in the state where our patients are located?
7. Where are your radiologists physically located when they sign a report?
8. How long does it take you to credential radiologists for a new facility or a new state, and do you use the IMLC?
9. Will you provide license and board certification documentation for every radiologist assigned to us?
10. Who maintains hospital privileges where our contracts require them?

Subspecialty and quality

11. Which fellowship-trained subspecialty sections will read our specific modality mix?
12. What percentage of signed reports are independently double-read?
13. What is your major discrepancy rate, and how is a discrepancy defined and adjudicated?
14. How are critical findings communicated, and what is the documented notification workflow?
15. For mammography, are your radiologists qualified under the FDA's Mammography Quality Standards Act (MQSA), which sets who is qualified to read a mammogram?

Pricing and contract

16. What is the all-in price per study for our exact case mix, including every fee?
17. Are there volume minimums, subscriptions, platform fees, or integration fees?
18. How are STAT and after-hours reads priced, and is the multiplier printed on the rate card?
19. What are the contract term, termination rights, and price escalation clauses?
20. Does a change of company ownership trigger a right to terminate?

Technology and compliance

21. How do studies reach you: DICOM from our PACS, portal upload, or a required integration project?
22. How are final signed reports delivered, and do you support HL7 or FHIR back into our systems?
23. Will you sign a Business Associate Agreement, and can you produce a safeguards summary mapped to the HIPAA Security Rule categories?
24. Where is PHI stored, and if any of our data touches EU jurisdictions, will you sign a data processing agreement as our processor?
25. Who owns the company today, and has ownership changed in the last five years?

Score the responses by how many come back as a number, a document, or a named process. That count sorts your shortlist faster than any reference call.

Six red flags that should end a conversation

Six answers should end the conversation: unpublished SLAs, contradictory turnaround claims, ownership churn, a mandatory platform migration, a headline rate that hides the price, and QA with no numbers attached.

Unpublished SLAs. If turnaround commitments appear nowhere on the website and nowhere in the contract template, the vendor has decided to stay unmeasured. "Industry-leading turnaround" is a null answer.

Turnaround claims that contradict each other. This one is easy to demonstrate, and pointing at it is an observation rather than an accusation. USARAD's homepage publishes "20 min or less" as the average report turnaround for STAT cases, while its services page states in capitals that the current average turnaround for hospital ER cases is 30 to 60 minutes. Both sentences were live on 10 August 2026, and the two figures may simply be scoped to different things, which is exactly the problem: the scope is not stated on either page. Read every page of a vendor's site before the sales call, then ask which figure applies to your studies and on what clock.

Ownership churn. An acquisition mid-contract can change your radiologist roster, your platform, and eventually your pricing. Ask question 25 directly, then put a change-of-control termination right in the contract so the answer stays useful.

Mandatory platform migration. Requiring you to adopt a proprietary worklist or viewer before the first read is an integration project billed as onboarding, and it makes leaving expensive. Prefer a vendor that accepts DICOM from your existing PACS, or a portal upload, on day one.

A headline rate that hides the price. A low advertised per-study rate paired with monthly minimums, platform fees, and unlisted STAT surcharges is a pricing model built to be misread. Insist on question 16 and compare only all-in numbers.

QA with no numbers attached. "Rigorous peer review" with no double-read percentage and no discrepancy rate describes a process that exists only on the website.

How do teleradiology companies structure their pricing?

Teleradiology pricing comes in three structures, and the structure moves your effective cost further than the headline rate does: per-report with no minimums, contracts with committed minimums, and FTE-equivalent subscriptions.

Model	How it works	Best for	Watch out for
Per-report, no minimums	You pay a listed rate per signed report, by modality. Volume can be one study or ten thousand.	Imaging centers with variable volume, overflow and backlog work, groups trialing a vendor	Confirm the STAT multiplier is printed on the rate card and applied at the published factor
Contract with minimums	Lower headline rate in exchange for a committed monthly volume or spend floor	High, stable volume with a predictable case mix	You pay the floor in slow months, and surcharges and platform fees often sit outside the headline rate
FTE-equivalent or subscription	You buy dedicated radiologist capacity in blocks, priced like staffing	Hospitals replacing a full internal shift, long-term nighthawk coverage	Highest fixed cost, capacity you do not use is still billed, and it is the hardest model to exit

Industry-typical per-study rates vary widely by modality, from low double digits for plain film X-ray to several times that for advanced cross-sectional and PET-CT work; those are industry figures, not AstraRad's. Most vendors quote only after a sales process, so the structural question is the useful one: are you paying for reports you receive, or for capacity you might not use? The build-versus-buy version of that math sits in the in-house vs outsourced radiology comparison.

AstraRad uses the first model only: per signed report, no minimums, no subscriptions, no platform fees, with the priority multiplier printed on the rate card. The per-report pricing page sets out the structure. Ask us for a rate card and the complete document, every study type listed, comes back within one business day.

The 25 questions are really testing one thing. A vendor who will write down a turnaround definition, a discrepancy rate, a licensure attestation and an all-in price has agreed in advance to be measured on all four, and that agreement is what you still hold when the sales team you liked has moved on and a new owner is reading the same contract. That is what it means to choose a teleradiology company on evidence. Ownership changes hands. Written answers stay yours. Each checklist item above has a deeper article behind it in the teleradiology resource library.