A teleradiology system acquires radiographic images from one location and transmits them to one or more distant sites where they are displayed and/or converted to hardcopy film recordings. The long term goal of this research is to demonstrate that teleradiology systems can provide diagnostically equivalent results when compared to conventional radiographic film interpretation. If this hypothesis is proven, the following radiology tasks will be improved: (1) providing for primary interpretation of radiological images for patients in under served areas as well as other medical facilities; (2) integration of radiological services for multi- hospital/clinic health care provides consortiums (HMOs); (3) improving emergency service and intensive care unit coverage; (4) offering consulting-at-a-distance with sub-speciality radiologists; and (5) providing radiologists in the community or in rural areas immediate access to large academic centers for help in the interpretation of difficult and problematic cases. We are designing a high-speed, high-resolution teleradiology system between our level I medical center and several outlying medical centers within the metropolitan area. CT, MR and screen-film examinations will be digitized to 2 K or 4 K at the remote sites, transmitted to the central referral facility and sent to a laser film printer, reproducing the original film. The film can then be used for primary diagnosis, overreading/consultative purposes or for emergency room preparation. Inherently digital modality data (e.g. MR and CT) can be sent without digitization of the multi-format film is desired. A teleradiology system using a Wide Area Network (WAN) is to be connected to the following sites: (1) Olive View Medical Center; (2) Harbor General Medical Center; (3) UCLA Department of Radiological Sciences; and (4) two radiologist''s private residences. The wide area network (WAN) consists of a local carrier (GTE California Incorporated) and an inter-exchange carrier (US Sprint). Each affiliated hospital site is equipped with: (1) a radiographic film digitizer; (2) an interactive grayscale display workstation; (3) a computer system with teleradiology application software; (4) a local area network (LAN); (5) a LAN-WAN router; and (6) and dial-up (multiple switched N X 56 kbps lines) DS-1 WAN interfaces. The UCLA site is equipped with a local area image management network (PACS) for archiving, displaying, laser printed film hardcopy recordings, and WAN interfaces. The radiologists private residence is equipped with a grayscale station and a DS-0 56 kbps modem. We estimate the hardware costs at each remote site to be $DLR160,000, $DLR200,000 for the central referring facility, and under $DLR20,000 for the radiologist private residence.