Our goal was to develop an inexpensive, high-quality, multi-site telemammography system, implemented with low-level data connections that provided a communication link for an “almost real-time” response from a radiologist (central site) to remote “underserved” sites. The remote sites digitize mammographic films using high-resolution, laser digitizers. Images are automatically cropped, compressed (wavelet-based), and encrypted prior to transmission. At the central site images are decrypted, decompressed, unsharp masked, and displayed using automatically determined LUTs. The sites communicate instantly via a “chat box.” Remote sites 1, 2, and 3 are 15, 20, and 90 miles from the central site, respectively, and connected by POTS (sites 1 and 2) and LAN (site 3). Only minimal noticeable difference at compression levels of 50:1 and 75:1 could be identified unless magnified to extreme levels. Two experienced observers rated the LUTs for 200 images as “acceptable” to “excellent.” Average cycle times to digitize, transmit and receive cases (four films each) at 75:1 compression were 5.97, 6.85, and 5.77 min/case from sites 1, 2, and 3, respectively. Unique data-handling schemes significantly decrease the image file size and allow successful transmission in a reliable, timely manner. Over 1000 cases have been transmitted to date. Messaging was found to be easy to use.