Abstract: For a majority of applications, teleradiology has been regarded primarily as a convenience for the on-call radiologist by transmitting radiographic images to the his/her residence so that an after-hour trip to the hospital can be avoided. Under such a operation environment, the images acquired and transmitted are not designed to meet the requirements of primary interpretation. The image quality required is relatively low order since the original films will be reviewed and dictated the following day. Currently teleradiology is being seriously considered as the means for doing primary diagnosis. In other words, a final diagnosis report will be generated by interpreting the soft copy of the image displayed on the monitor without any reference to the original film. Such a paradigm shift raised many technical as well as clinical issues that must be addressed. The radiology department of Texas Tech University Health Sciences Center began efforts in teleradiology since March 1994. A number of key issues and experiences learned from our practising teleradiology in the past several months are presented in this paper.