The purpose of this study was to assess the effect of ATM network capabilities on the clinical practice of regional teleradiology, by providing immediate interactive radiology consultations between subspecialists and general radiologists at affiliated academic institutions. PACS installed at three affiliated hospitals (UCLA Medical Center, West LA VAMC and UCLA Olive-View Medical Centers) were connected via an ATM network. Two commercial PACS (Agfa) systems, one at the VAMC and one in an ultrasound outpatient clinic at UCLA were connected via ATM switches (Newbridge, Inc.) and a Santa Monica GTE central office switch. We evaluated this initial system configuration and measured image transfer performance, including memory-to-memory, disk-to-disk, disk-to-archive with and without DICOM protocols. Although the memory-to-memory data rate was 25 Mbps, the average remote disk-to-disk image transfer performance, using DICOM 3.0 communications protocols on SUN SPARCstation 10 servers, was 3 to 5 Mbps. Using these capabilities, timely interactive subspecialty consultations between radiologists was successfully performed while both were at different physical locations. We present the use of ATM technology in a realistic clinical environment and evaluate its impact on patient care and clinical teaching within the radiology departments of 2 institutions. Image communications over a regional PACS using an ATM network can allow interactive consultations between different subspecialist and general radiologists or other specialized radiologist spread over three different medical centers.