How Does Teleradiology Connect to Your PACS and RIS?

This guide is for imaging center operators and the PACS and IT administrators who will set up the connection. Teleradiology adds a reading service to the systems you already run. It does not replace your PACS, your RIS or your own radiologists.

Section 1 How does teleradiology connect to an imaging center's PACS and RIS?

Through two lanes, one for images and one for orders and reports. The image lane runs on DICOM, which is not a software package but a set of specifications for exchanging medical imaging information [1]. When your PACS sends a study to a reading group, it uses DICOM's storage service, which lets one system send images and related objects to another; the transfer itself is a C-STORE, often called a DICOM push [2].

The second lane carries orders and reports, either as HL7 messages between your RIS and the reading group, or through a secure web portal, where staff upload the study with its clinical context and later download the finished report.

The ACR-AAPM-SIIM Technical Standard for Electronic Practice of Medical Imaging lists sending images to remote sites for formal interpretation among the goals of electronic imaging practice, along with providing subspecialty support as needed [3]. Your PACS remains your archive and your RIS your system of record; the reading group becomes one more destination your images can reach.

Section 2 What moves between the imaging center and the reading group?

Six things, and each one needs a path:

• The images: the study in standard DICOM, at the full spatial and contrast resolution the modality created for interpretation, as the ACR-AAPM-SIIM standard recommends [3].
• Prior studies: sending today's study does not, by itself, send the priors. In DICOM, support for storage does not necessarily include query and retrieve, the separate capability used to fetch earlier exams [2], and the ACR practice parameter on communicating imaging findings treats comparison with relevant examinations and reports as part of the report when appropriate and available [4].
• The order and clinical history: ACR guidance says a request for imaging should include relevant clinical information, such as pertinent signs and symptoms, and that a specific question to be answered can help [4]. The ACR-AAPM-SIIM standard adds that complete and consistent demographic data should transfer across all systems [3].
• The worklist: the reading group's queue of studies that have been performed and are waiting to be read. Your routing decides which studies land on it. It is a different list from the modality worklist, which carries demographic and scheduling data to your scanners [3].
• The signed report: ACR guidance says the final report should go to the referring physician or other health care provider, and that the imaging facility should archive a copy as part of the patient's medical record [4].
• Urgent findings: ACR guidance expects findings that suggest a need for immediate or urgent intervention, findings discrepant with an earlier interpretation of the same exam where failure to act may adversely affect patient health, and findings the radiologist reasonably believes are significant and unexpected to be communicated outside the routine report, with every such communication documented [4].

Section 3 What are the common teleradiology connection options?

There are four common building blocks, and a center can combine them:

• DICOM routing: your PACS, or a DICOM router in front of it, forwards studies to the reading group's destination with C-STORE [2]. Which studies leave, by modality, location or priority, is a rule you configure in the PACS or router. DICOM defines the transfer, not the routing rule.
• A secure web portal: staff upload the study and its clinical context in a browser, and download the finished report from the same workspace.
• HL7 messages: in HL7 version 2, a messaging standard for clinical data, an imaging order travels as an OMI message, or as the older ORM message that HL7's own tables now mark deprecated, and a result such as a signed report travels as an ORU message [5]. The ACR-AAPM-SIIM standard names DICOM and HL7 as the building blocks for moving order and patient data electronically, and recommends IHE's Scheduled Workflow profile for ordering, scheduling, acquisition and image transfer [3].
• Encrypted transport: DICOM defines how to encrypt its traditional transfers with TLS and its web services with HTTPS, but it facilitates encryption rather than mandating it [1]. Facilities can instead set up an encrypted VPN and send unencrypted DICOM inside it, an arrangement the DICOM committee calls quite common between sites but says may not be advisable from a cybersecurity point of view [1].

Section 4 What does an imaging center need to prepare?

Settle six things before the first study moves:

• Network and routing details: the destination your PACS will send to, the rules for which studies leave, and a link sized for your expected volume, as the ACR-AAPM-SIIM standard recommends [3].
• Priors and comparison studies: how earlier exams will reach the reader, whether sent with each study, retrieved on request or uploaded, and which ones count as relevant.
• Complete order and history data: the reason for the exam, pertinent signs and symptoms and the question to be answered, attached to every order.
• A report delivery destination: where the signed report lands, who at your center retrieves it, and how it reaches the referring provider. If it needs to appear in your RIS or EHR, raise that at the start.
• A critical results path: who the reading radiologist contacts, whether by phone, in person or electronically with documented receipt, and where each communication is recorded [4]. ACR guidance adds that any written communication policy, to be effective, must be followed and shared within the institution the radiologists serve [4].
• Test studies before go-live: the ACR-AAPM-SIIM standard calls for acceptance and integration testing whenever a PACS, RIS or reporting system is introduced or modified, and ongoing verification that exams actually arrive for interpretation [3]. It notes that images can fail to send or store because of information mismatches with an information system [3].

If you are still choosing a coverage model, how imaging centers outsource radiology reading explains the models and the questions to ask before you sign.

Section 5 How is patient data protected in transit?

Under HIPAA's Security Rule, covered entities and business associates must implement technical security measures that guard against unauthorized access to electronic patient data sent over a network [6]. That transmission security standard lists two implementation specifications, integrity controls and encryption, and marks both as addressable [6].

Addressable does not mean optional. For each addressable specification, an organization must assess whether it is reasonable and appropriate, implement it if it is, and if it is not, document why and implement an equivalent alternative measure if reasonable and appropriate [7]. The same technical safeguards section also covers access control, audit controls that record system activity, and verifying that anyone seeking access is who they claim to be [6].

A business associate agreement, or BAA, is the written assurance HIPAA requires before a covered entity shares patient data with a business associate [8]. HHS also recognizes a treatment exception: a covered entity does not need a BAA to disclose information to a health care provider for the patient's treatment [8]. Whether a given reading arrangement needs one depends on its facts, so settle that with your compliance or legal team. HHS's examples of business associates include cloud services and IT vendors that handle patient data on your behalf [8].

Four questions test any reading group on this: how is each lane encrypted, who can reach your studies, what gets logged, and will the group share its security documentation?

Section 6 How does Expert Radiology connect?

We slot into your PACS and turnaround windows. Expert Radiology is a reading service, not a software vendor: your PACS, RIS, technologists and radiologists stay in place, and our radiologists read alongside yours. Studies reach us in one of two ways:

• Direct DICOM routing from your existing PACS. We are DICOM compatible, so your center sends the study the same way it sends anything else, with no new workflow for your technologists and no new hardware.
• Submission through the ExRad Portal, a secure workspace that runs in any modern web browser with no downloads or plugins. Upload the study, select the service, add clinical context and submit.

Finished reports come back the way your workflow needs them: returned to your RIS over an interface, or delivered through the portal, where your team can track each case from intake to final report and download the completed report. Which path you use is scoped during onboarding. Our MRI reads come back as PrecisionPlus v3™ reports.

Urgent findings do not wait for the report. The reading radiologist phones the ordering provider or your center's designated contact, and the communication is documented in the report. Questions about a read go through the portal or your account contact, and the radiologist who read the study calls you back.

Our infrastructure is built for HIPAA-regulated imaging workflows: data is encrypted in transit and at rest, access is role-based with audit logging and session timeouts, and BAAs are signed as part of onboarding where required. The specific controls, versions and standards are set out in our security documentation, which can be reviewed during diligence.

Expert Radiology has interpreted 400K+ MRIs and served 350+ facilities nationwide, and our radiologists are 100% board-certified and subspecialty-focused. See how we work with imaging centers.

Bring your routing rules and report delivery questions, and scope coverage and integration with us.