Integration & implementation
Connected systems, tested before go-live.
Teleradiology depends on four flows working every time: images, orders, prior studies and reports. Implementation gives each flow an owner, builds the connection and proves the whole pathway before the first patient study.
How a study moves
Six systems, one pathway.
Integration is planned around your existing systems. Compatibility, interface needs and any required changes are confirmed during scoping.
- ModalityAcquires the images
- PACSStores and sends by DICOM
- Secure connectionVPN or TLS, agreed with IT
- Reading worklistPrioritized and matched
- Signed reportPreliminary or final
- RIS, EHR or PACSFiled where clinicians look
Responsibility map
Who owns each flow.
Choose a flow to see what your facility owns, what the reading service owns, what is agreed together, and the test that proves it before go-live.
Orders & history
Your facility
- Order entry with the reason for examination
- Protocol selection and technologist notes
- Priority set at ordering or acquisition
Reading service
- Receives order details with the study
- Flags missing history through the agreed route
Agreed together
- Order interface or worklist format
- Priority mapping: STAT, urgent, routine
Test before go-live: An order with a known reason for examination appears correctly in the reading worklist.
Images
Your facility
- Complete acquisition
- Sending from PACS or modality
- Local network and firewall changes
Reading service
- Receiving endpoint and storage
- Monitoring for studies that fail to arrive
Agreed together
- AE titles, ports and transport security
- Routing rules by modality and site
Test before go-live: Studies from every modality and site arrive complete, with correct identifiers.
Prior studies
Your facility
- Archive access or retrieval rules
- Outside imaging brought into PACS
Reading service
- Displays relevant priors at reading time
Agreed together
- Which priors are sent automatically and which on request
- How long priors are kept on the reading side
Test before go-live: A study with known priors shows them to the reader, in date order.
Worklist & assignment
Your facility
- Tells the reading side which studies are read locally
Reading service
- Case matching: modality, priority, licensure, privileges
- Backup when a reader is unavailable
Agreed together
- The rule for which studies route out
- Locking, so each study is opened by one reader
Test before go-live: A study routed for remote reading cannot be opened for dictation twice.
Reports
Your facility
- Receiving systems: RIS, EHR, PACS and referrer delivery
Reading service
- Signed report in the agreed format
- Addenda and corrected reports
Agreed together
- HL7 results, a document to PACS, or portal access
- Report status and notification of changes
Test before go-live: A signed report and a later addendum both reach every destination.
Urgent findings
Your facility
- Call list by location and time of day
- Escalation when the ordering clinician is unavailable
Reading service
- Calls, and documents the nonroutine communication
Agreed together
- Where and how calls are documented
- Periodic review of urgent communications
Test before go-live: A rehearsed call reaches the right person and is recorded.
Downtime
Your facility
- Local downtime procedure and contacts
Reading service
- Monitoring, notification and recovery on the reading side
Agreed together
- Fallback route for urgent studies
- Reconciliation after recovery
Test before go-live: A walkthrough ends with every study read during downtime reconciled.
Integration options
Common options, and what to watch.
DICOM carries images and HL7 carries orders and results in most radiology departments; IHE’s Scheduled Workflow profile describes how the two fit together. The right choice for each flow depends on your systems and your IT team’s standards.
| Flow | Common options | Watch for |
|---|---|---|
| Images | DICOM send from PACS or modality over a VPN or TLS connection; a gateway appliance; DICOMweb | AE titles, ports and certificates that expire; routing failures that nobody notices |
| Orders & history | HL7 order messages; a DICOM modality worklist; scanned requisitions | Priority mapping, and free-text history lost between systems |
| Prior studies | Sent with the new study; retrieved on request; viewer access to the archive | Which priors count as relevant, and how long they are kept on the reading side |
| Reports | HL7 results to RIS or EHR; a document or DICOM structured report to PACS; portal access | Addenda reaching every destination, and report status updates |
| Identifiers | Medical record number with its issuing facility; site prefixes on accession numbers | Collisions between sites, merges and corrections |
Exception handling
When something doesn’t arrive as expected.
Every pathway has bad days. These are the exceptions worth rehearsing before go-live, and what should happen in each.
Images arrive incomplete
- The reader stops before reporting on partial data.
- The facility contact hears what is missing, through the agreed route.
- The study returns to the worklist when complete, and the delay is recorded as an exception rather than hidden in turnaround.
A relevant prior is not available
- The reader checks the agreed prior sources.
- If a relevant prior exists but cannot be retrieved, the report says so and a request goes to the facility.
- If the prior later changes the interpretation, an addendum follows.
The order or history is missing
- The reader asks through the named contact route instead of guessing.
- Urgent studies are read with what is available, and the limitation is stated.
- Recurring gaps are reviewed with the facility, usually as an order-entry fix.
An urgent finding at 02:00
- The reader calls the clinician on the call list for that location and hour.
- If nobody answers, the documented escalation takes over.
- The call is documented: who was reached, when, and what was communicated.
An interface goes down
- Define how interrupted study flow is detected, who alerts the other team and when the fallback route takes over.
- Urgent studies use the fallback route agreed in the downtime procedure.
- After recovery, both sides reconcile everything read during the downtime.
Identifiers do not match
- The study is held, not read against the wrong record.
- The facility corrects the identifiers at the source.
- Repeated mismatches lead to a routing or numbering fix.
A report needs correcting
- The reader issues an addendum, preserving the original report.
- A significant change is communicated directly to the clinician who acted on the first version.
- The event feeds peer review and discrepancy follow-up.
Implementation
Five stages, two in parallel.
Eligibility and connectivity usually take the longest, so they start as soon as the scope is clear and run side by side.
Scope
Examinations, windows, priorities, report types and onsite boundaries written down, starting from your coverage brief.
Eligibility & agreements
Licensure, credentialing and privileges; the service agreement; privacy and security review, including a business associate agreement where required.
Runs in parallelConnectivity
Image, order, prior and report routes built and tested with approved test data.
Runs in parallelValidation
End-to-end test studies, delivery to every destination, an urgent-call drill and a downtime walkthrough.
Go-live & first review
A closely watched start and an early review of routing, communication and measures while issues are small.
What to prepare for each stage is in the onboarding checklist.
AI, carefully
An area of evaluation, not a feature.
Interpretation and reporting in the Radstead service are physician-led. AI is an area Radstead evaluates for future use, and no AI tool is part of the reading service described on this site.
The FDA publishes a list of AI-enabled medical devices authorized for marketing in the United States. It is a useful starting point, not a substitute for local evaluation.
What any tool would need first
- A specific task and a measurable benefit to patients or clinicians
- Regulatory status appropriate to its intended use
- Local validation on representative studies before clinical use
- Radiologist oversight, with outputs visible and open to challenge
- A fallback workflow for when the tool is unavailable
- Monitoring after introduction, and a way to switch it off
Areas being evaluated
- Worklist support
- Helping surface studies that may need attention sooner, under radiologist control of priority.
- Reporting consistency
- Checks for completeness and internal consistency, with the physician approving every word.
- Operational insight
- Understanding volume patterns and exceptions, with clear data-handling rules.
Questions
Technical questions, early.
Do we need to replace our PACS or RIS?
The starting point is your existing PACS and RIS. Confirm compatibility, interface needs and any required changes during integration planning, using your system names and current report workflow.
Is a VPN required?
Not necessarily. Site-to-site VPNs and TLS-secured connections are both common. The choice is made with your IT team against your security standards, and network details are exchanged through their process, not by email.
How are prior studies made available?
They can be sent with each new study, retrieved on request, or viewed through archive access. The agreement defines which priors count as relevant and how long copies are kept on the reading side.
What happens if the connection goes down?
The implementation plan defines how an interruption is detected, who alerts the other team and when the fallback route takes over. Both sides agree the downtime procedure and how studies read during an outage will be reconciled afterwards.
Can we send images through this website?
No. This website is for business information only. Patient information and studies move only through the clinical connections established for an agreed service.
References
Primary sources
Standards and public resources referred to on this page.
- DICOM Standard, current editionMedical Imaging & Technology Alliance, a division of NEMA
- Scheduled Workflow integration profileIHE International
- ACR–AAPM–SIIM Technical Standard for Electronic Practice of Medical ImagingAmerican College of Radiology · Revised 2022
- List of Artificial Intelligence-Enabled Medical DevicesU.S. Food and Drug Administration
- When is a health care provider a business associate of another health care provider?U.S. Department of Health and Human Services
Coverage planner
Bring your scope into focus.
Modalities, priorities, hours and systems on one page. The planner prepares a brief in your browser that you can download, copy or email to the contact you choose.