What is teleradiology? How it works, step by step

An imaging suite that finishes a CT at 9 p.m. and holds it until morning is paying for that wait. The bed stays occupied, the patient cannot be dispositioned, and the referring physician keeps calling the front desk for a report nobody can hand over yet. Teleradiology closes that gap: it is the transmission of medical images from one location to another so a radiologist can interpret them remotely and return a diagnostic report. The study leaves the facility as DICOM data, a board-certified subspecialist opens it on a diagnostic workstation, and a final signed report comes back electronically against a stated turnaround tier: under 1 hour for STAT work, under 24 hours for routine.

A remote radiologist opens the identical DICOM data

Medical images travel in DICOM, the standard every scanner and PACS (image archive) on the market conforms to. When a radiologist in another state pulls up your study, they get the same pixel data, the same series, the same window levels, and the same clinical history a colleague down the hall from the scanner would get. Nothing is compressed for transit or flattened into a screenshot.

What happens next is a physician judgment. A neuroradiologist follows a hyperdensity across contiguous slices, decides whether it is blood or beam hardening, checks the prior from eight months ago, and puts a name on it in a report they sign under their own license. That work is identical at a workstation four states away and at one bolted to the wall behind the scanner.

Teleradiology sits inside telemedicine, and the difference is the encounter. Telemedicine usually means a live patient visit by video or phone. In teleradiology the physician never meets the patient: the work product is the diagnostic report that goes to the ordering physician, and when a finding is critical the radiologist gets that physician on the phone directly.

How does teleradiology work, step by step?

A teleradiology study moves through five standardized stages, acquisition through delivery, which is why a facility can send its first study this week without an integration project.

Step 1: nothing changes at the scanner

The study is acquired exactly as it would be for an on-site read, including protocol requirements like contrast phases for CT or positioning views for mammography. Clinical history is the one thing worth extra care. A radiologist who receives the indication, the relevant priors, and the specific question the ordering physician is asking writes a more useful report than one working from an accession number and a body part.

Step 2: DICOM leaves the facility two ways

Facilities with a PACS configure a DICOM send destination, which is routine work for any PACS administrator, and studies flow automatically from then on. Facilities without a PACS, or those pushing occasional overflow, upload through an encrypted web portal. AstraRad, a subspecialist teleradiology practice, accepts both, and your PACS stays your PACS.

Step 3: subspecialty routing decides who reads

A general radiologist covering a community hospital reads whatever arrives that shift: the knee, the head CT, the pediatric abdomen, the screening mammogram. A large panel routes each study by anatomy instead, so a child's abdominal CT reaches a pediatric radiologist and a cardiac MRI reaches someone who reads cardiac MRI every working day. Priority rides alongside subspecialty, so a STAT head CT moves ahead of a routine knee.

Step 4: interpretation and signature

The radiologist reads on diagnostic-grade displays, compares against priors when they are available, and dictates a structured report. The interpreting physician signs it as the physician of record. Every AstraRad radiologist is physically located in the United States and licensed in the state where your patients are, which is what final signed reports and professional-component billing both require.

Step 5: delivery back into your systems

The signed report lands in your RIS (reporting system) or EHR (electronic health record) over an HL7 or FHIR feed, or in the portal, timestamped against the tier it was sent under. AstraRad's tiers are STAT under 1 hour, urgent under 4 hours, and routine under 24 hours, each measured from last-image arrival to radiologist signature, with performance published in the SLA.

Who uses teleradiology?

Hospitals and emergency departments, imaging centers, urgent care groups, and mobile imaging operators are the four main buyers of teleradiology, and each is buying coverage it cannot economically staff on site.

• Hospitals and emergency departments buy overnight and weekend coverage, the model historically called nighthawk radiology. At 3 a.m. an ED may need a head CT read in minutes and then need nothing for two hours. Shift-based coverage means the physician who reads it is on the clock and awake for it.
• Imaging centers buy subspecialty depth they cannot staff locally, plus overflow capacity when volume spikes. An 8,000-study backlog clears in under 30 days on AstraRad's panel, which carries headroom for 25,000 additional studies per month.
• Urgent care groups send plain film and CT for fast turnaround without employing radiologists at all.
• Mobile imaging and portable X-ray operators have no fixed reading room by definition, so remote interpretation is the native model.

The thread running through all four is that radiology demand refuses to hold still. A flu season fills the ED with chest films for six weeks and then empties it. One new referring practice can add a hundred studies a month with no warning, and take them away again when a physician there retires. A scanner upgrade raises capacity months before it raises volume, and the gap between the two shows up in payroll either way. An employed radiologist is a fixed cost against all of it. Compensation, benefits, malpractice premium, and vacation coverage cost the same in a slow February as they do in a busy October. The usual response is to staff to the average, which quietly buys two failure modes at once, queues in the busy weeks and idle physician hours in the slow ones. Per-report teleradiology turns that variance into a line item you can read, because you pay for interpretations you received. That is why the model spread out of overnight coverage, where it started, into daytime overflow and subspecialty depth. It also changes what a bad month looks like: a slow month is a smaller invoice, and a backlog month becomes a routing decision that takes an afternoon.

One case teleradiology does not cover: work that needs a physician in the room, such as fluoroscopy, image-guided procedures, and contrast supervision, still requires an on-site radiologist.

Preliminary reads leave the second half of the job undone

A preliminary read is a rapid overnight interpretation used for immediate clinical decisions. The ED acts on it that night, and an on-site radiologist issues the final interpretation the next morning, which means two physicians have now looked at the same study to produce one billable report. A final read is the signed report of record and no second interpretation follows it. The distinction drives billing and liability, and it is worked through in STAT vs preliminary vs final reads.

AstraRad signs finals. Finals ask more of a provider: the physician has to be credentialed at your facility and licensed for the patient's state before the first study arrives, which is why credentialing depth is one of the first things to test when choosing a teleradiology company.

Accuracy is the fair question, and it has a measurable answer. Since the image data is the same, quality reduces to two things you can audit: who reads, and what the provider does with its own signed reports afterward. On the first, ask for board certification and fellowship training that matches the study mix you actually send. On the second, ask what fraction of reports get an independent second interpretation and what happens when the two physicians disagree. AstraRad double-reads 1 in 20 signed reports independently. Major discrepancies run under 0.3% of signed reports, and every one is reviewed at the monthly discrepancy meeting and closed with the reader who signed it.

Compliance is the other half of due diligence. A credible provider operates under HIPAA in the US and GDPR where European data is involved, moves imaging over encrypted DICOM-conformant channels, and returns reports through standards-based HL7 and FHIR interfaces. Mammography adds a requirement: interpreting physicians must meet the standards of the FDA's Mammography Quality Standards Act (MQSA), which sets who is qualified to read a mammogram, wherever they sit.

What does teleradiology cost, and how do pricing models work in 2026?

Nearly every teleradiology provider prices per report, with the fee scaling by modality and complexity: industry-typical pricing puts plain film and mammography at the low end, ultrasound in the middle, and CT, MRI, and PET-CT at the top. Those ranges are industry figures, not AstraRad's. What drives per-study fees is broken down in the teleradiology cost guide.

Three contract terms move the annual number more than the headline rate does.

Minimums and subscriptions. Committed monthly volume or a platform subscription penalizes exactly the variable-volume facilities that need teleradiology most. AstraRad has no minimums, no subscriptions, and no platform fees.

Priority multipliers in writing. STAT costs more than routine everywhere in this market. The question is whether the multiplier is printed on the rate card or discovered on an invoice. AstraRad prints it on the rate card.

Coverage of your study mix. Read the rate card against what you send: CR X-ray, mammography, ultrasound, CT including double abdomen and pelvis and coronary CTA, MRI including advanced and cardiac, nuclear medicine gamma, and PET-CT. A gap here is where surprise pricing lives.

The pricing page lists what AstraRad prices per report, and you can ask us for a rate card directly.

Judge a panel by what it publishes

A teleradiology panel is judged by what it publishes: turnaround with its measurement method, the double-read rate, discrepancy handling, and a rate card you can read before you sign. Everything above turns into questions you can put to a provider before signing anything.

Ask which subspecialties sit on the panel, and who specifically would read a pediatric abdominal CT at 2 a.m. Ask for turnaround stated with its window and its instrument: what share of reports landed inside their tier, measured over which months, counted from what timestamp. Ask what percentage of signed reports get an independent double-read, and ask to see what the provider does with a disagreement once it finds one. Ask where the radiologists are physically located and which state licenses they hold, and check what coverage looks like in your own metro market.

Then read the rate card line by line against a month of your own volume. A provider that publishes its own numbers has already agreed to be measured by them. The full set of definitions and comparisons is in the teleradiology resource library.