Teleradiology is the transmission of medical images from one location to another so a radiologist can interpret them remotely and return a diagnostic report. In practice, an imaging center or hospital sends CT, MRI, X-ray, ultrasound, mammography, or nuclear medicine studies as DICOM files to an off-site radiologist, who reads them on diagnostic workstations and returns a signed report against a defined turnaround commitment, commonly under 1 hour for STAT studies and under 24 hours for routine work. At AstraRad, that model runs at scale: 600,000 reads per year interpreted by 240 board-certified, fellowship-trained subspecialists, with a median STAT turnaround of 28 minutes and 99.4 percent SLA compliance over the trailing 12 months.
Teleradiology defined
The core idea is simple: the images travel to the radiologist instead of the radiologist traveling to the images. A CT acquired in a suburban imaging center at 9 pm can be interpreted by a fellowship-trained neuroradiologist three time zones away and returned as a final, signed report before the patient has left the building.
What makes this clinically equivalent to an on-site read is the data itself. Medical images are stored and transmitted in DICOM, the universal standard for medical imaging. A remote radiologist reviews the exact same pixel data, the same series, and the same clinical history as a radiologist sitting down the hall from the scanner. The physical location of the reader does not change what the reader sees.
Teleradiology is a subset of telemedicine, but it differs in one important way: there is no live patient encounter. The radiologist's work product is the diagnostic report, delivered to the ordering physician or facility, not a video visit with the patient.
How does teleradiology work, step by step?
For an imaging center director evaluating remote reads for the first time, the workflow has five stages. Each one is standardized, which is why a well-run teleradiology relationship requires no integration project to begin.
| Step | What happens | Who does it |
|---|---|---|
| 1. Acquisition | The technologist performs the study on the scanner as usual | Imaging site |
| 2. Transfer | The study moves as DICOM, sent directly from PACS or uploaded through a secure portal | Imaging site |
| 3. Routing | The platform matches the study to a radiologist by subspecialty and priority tier | Teleradiology provider |
| 4. Interpretation | A board-certified radiologist reads the study and signs the report | Reading radiologist |
| 5. Delivery | The signed report returns electronically via HL7, FHIR, or portal, timestamped against its SLA | Teleradiology provider |
Step 1: Acquisition
Nothing changes at the point of care. The study is performed exactly as it would be for an on-site read, including any protocol requirements such as contrast phases for CT or positioning views for mammography. Good clinical history transmitted with the study measurably improves report quality, so most providers ask for the indication, relevant priors, and the ordering physician's question.
Step 2: DICOM transfer
Studies leave the site one of two ways. Facilities with a PACS configure a DICOM send destination, a routine task for any PACS administrator, and studies flow automatically. Facilities without a PACS, or those sending occasional overflow, upload through an encrypted web portal. AstraRad supports both: DICOM from PACS or portal upload, with no integration project required to send the first study.
Step 3: Subspecialty routing
This is where teleradiology at scale outperforms a small on-site group. A general radiologist covering a community hospital reads whatever arrives. A large distributed panel routes each study to a reader trained in that exact anatomy: neuro, MSK, body, cardiac, breast, pediatric, chest, ER, oncologic, or nuclear imaging. Routing also respects priority, so a STAT head CT jumps the queue ahead of a routine knee MRI.
Step 4: Interpretation and signature
The radiologist reads on diagnostic-grade workstations, compares against priors when available, and dictates a structured report. For final reads, the interpreting radiologist signs the report as the physician of record. Providers serving US patients staff radiologists licensed in the state where the patient is located, which is the licensing model AstraRad follows.
Step 5: Delivery
The signed report returns to the facility electronically, by HL7 or FHIR feed into the RIS or EHR, or through the portal, and is timestamped against its service level. AstraRad's tiers are STAT under 1 hour, Urgent under 4 hours, and Routine under 24 hours, with performance published in the SLA.
Who uses teleradiology?
Four buyer profiles account for most of the market.
- Hospitals and emergency departments use teleradiology for overnight and weekend coverage, the model historically called nighthawk radiology. Instead of paying a radiologist to be awake at 3 am for a handful of studies, the ED sends STAT work to a panel that is already awake. Follow-the-sun staffing across time zones means the reader is working a normal daytime shift; AstraRad covers 24/7/365 across 12 time zones.
- Imaging centers use it for subspecialty depth they cannot staff locally, for overflow when volume spikes, and for backlog recovery. 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 networks send plain films and CT for rapid 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 common thread is elasticity. Radiology volume is lumpy: a flu season, a new referring practice, or a scanner upgrade can swing monthly study counts sharply in either direction, but an employed radiologist is a fixed cost regardless. Teleradiology converts that fixed cost into a variable one. Send one study a month or ten thousand; the panel absorbs the variation without the overhead of a larger employed group.
Preliminary vs final reads, and how quality is assured
Teleradiology reports come in two forms, and the distinction matters for billing and liability. A preliminary read is a rapid wet-read used for immediate clinical decisions, typically overnight, with an on-site radiologist issuing the final interpretation the next morning. A final read is the signed, billable report of record; no second interpretation follows. The full distinction, including when each makes sense, is covered in STAT vs preliminary vs final reads.
The market has shifted heavily toward final reads, because a preliminary-only service duplicates physician effort. Final reads require the remote radiologist to be fully credentialed at the facility and licensed for the patient's state, which is why credentialing depth is a core evaluation criterion when choosing a teleradiology company.
Accuracy is a fair question, and the answer is measurable. Remote reading changes nothing about the image data, so quality reduces to two things: who is reading and how the provider audits itself. On the first, look for board certification and fellowship training in the relevant subspecialty. On the second, look for a real quality assurance program with published numbers. AstraRad independently double-reads 1 in 20 reports and holds a major discrepancy rate under 0.3 percent.
Compliance is the other pillar. A credible provider operates under HIPAA in the US and GDPR where European data is involved, transmits imaging over encrypted DICOM-conformant channels, and delivers reports through standards-based HL7 and FHIR interfaces. Mammography adds a layer: interpreting physicians must meet FDA MQSA requirements regardless of where they sit.
What does teleradiology cost, and how do pricing models work in 2026?
Nearly every provider prices per report, with the fee scaling by modality and complexity. Industry-typical rates put plain film X-rays and mammography at the low end, ultrasound in the middle, and CT, MRI, and PET-CT at the top, with published industry pricing for some modalities starting in the low tens of dollars per study. A full breakdown of what drives per-study fees is in the teleradiology cost guide.
The structural differences between vendors matter more than the sticker price. Watch for three things:
- Minimums and subscriptions. Some contracts require committed monthly volume or a platform subscription, which penalizes variable-volume sites. AstraRad has no minimums, no subscriptions, and no platform fees.
- Priority pricing transparency. STAT reads cost more than routine reads everywhere. The question is whether the multiplier is printed on the rate card or discovered on the invoice. AstraRad prints the priority multiplier on the rate card.
- Coverage of your study mix. Confirm the rate card covers everything you actually 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.
AstraRad's model is per-report pricing across all of the above, detailed on the pricing page. Request a rate card through contact and it arrives within one business day.
The bottom line
Teleradiology moves images to radiologists instead of radiologists to images, using the same DICOM data, the same board-certified physicians, and standards-based delivery back into your systems. For imaging centers and hospitals, it converts a fixed staffing problem into an elastic, per-report service with measurable turnaround and quality. Evaluate providers on subspecialty depth, SLA performance with published compliance numbers, quality assurance you can audit, and pricing you can read before you sign.