We evaluated a telemammography system for reviewing and rating screening mammography in a clinical setting. Three remote sites transmitted 306 exams to a central site. Films were digitized at 50 micron pixel dimensions and compressed at a 50:1 ratio. At the central site images were displayed on a workstation with two high-resolution monitors. Five radiologists reviewed and rated the screens without the availability of prior images or additional information indicating: 1) if additional procedures were needed, 2) which breast was involved, and 3) when appropriate, the recommended additional procedures. During the actual clinical interpretation 13.7% (42 cases) of the patients were recalled for additional procedures. During the retrospective review radiologists 1, 2, 3, 4, and 5 recommended additional procedures for 26.1%, 29.1%, 36.3%, 45.1%, and 54.2% of the cases, respectively. The agreements between the clinical interpretation and radiologists 1, 2, 3, 4, and 5 were 77.8%, 76.1%, 69.0%, 62.7%, and 53.6%, respectively. The exceedingly high percentage of recommended additional procedures using the workstation was attributed to lack of prior images or additional information, the knowledge that case management was not affected, and the observers’ expectation for an enriched case mix.