WE STUDIED the effect of teleradiology (TR) for radiological consultation in a real life situation with an independent family practice center. The hypotheses tested were (1) that TR provides acceptable diagnostic accuracy and (2) that timely radiological consultation is of value to the family practitioner. In prospective and controlled fashion we performed parallel interpretation of roentgenograms and TR images of these roentgenograms. In addition to evaluating the accuracy of the radiological consultation, we investigated the impact of this report on the family practice physician and patient. MATERIALS AND METHODS The family practice center of the University of Iowa, Iowa City, is an autonomous, separate unit of the University of Iowa Hospitals and Clinics. The study group consisted of 200 consecutive patients who underwent radiography at the family practice center. The study was limited to roentgenograms of the chest and extremities, consistent with radiation protection laws and practice styles in Iowa.

Even when all available preventive strategies are strongly encouraged, the diagnosis of cancer will often be encountered in the primary care setting. Patients will look to their personal physician for advice in dealing with their illness and commonly ask, "What would you do?" Knowing the patient well, whether he or she desires to fight for every possible day of life or apparently welcomes an earlier death with freedom from life prolongation therapies, is the basis for helping the patient to choose alternatives. Informed decisions by the physician are facilitated by appropriate classification and staging of the tumor. Entrusted to the primary physician are numerous responsibilities that include team management, aiding the patient and family to cope with the illness, and maintaining a quality life with the best possible functional status. Both patient and physician must fully understand and share what is known about the cancer in order to individualize treatment with the proper level of care. Modern cancer care is highly sophisticated and changeable; to do it well requires a special interest and attention from the physician.