In 1998 we surveyed our radiologists on teleradiology satisfaction. Results were generally positive. In 2002 we experienced a sevenfold case increase in teleradiology volume. The present study surveyed the radiologists again. The hypothesis was that, with increased case volume and radiologist experience with the system, ratings would increase. Image quality was excellent/good, although plain film and ultra sound (US) had more fair/poor ratings. Monitors, navigation, image processing, and Web-based reporting were rated as excellent/good. The voice-recognition system was rated poorly. Diagnostic confidence was about the same as for film. Exceptions were magnetic resonance imaging (MRI) US, and plain film. Up to 10% of cases are unreadable because of poor image quality, not enough images, or inadequate patient history. Overall, the radiologists are satisfied, although some improvements can be made.