We developed a wireless personal digital assistant (PDA)-based teleradiology terminal which allowed a secure connection to the hospital's Picture Archiving and Communication System (PACS) through the DICOM protocol. Ten members of the hospital's medical staff completed a questionnaire about its mobility, usability, stability, performance and diagnostic efficiency in a real health-care environment. There was a high degree of satisfaction with the system's mobility (mean score 4.1, SD 1.0, on a five-point scale), usability (mean score 4.2, SD 1.1), stability (mean score 3.9, SD 0.4) and performance (mean score 4.2, SD 0.6). The system was evaluated as a tool for providing assistance in diagnosing thyroid nodules from ultrasound images. A total of 144 ultrasound images with thyroid nodules were assessed by an expert. Six image quality attributes were evaluated. The physician concluded that the ultrasound thyroid images on the PDA screen were of similar quality to those displayed on a diagnostic visual display unit screen. However, the expert found difficulties in diagnosing microcalcification, internal echo texture and vascularity. The PDA terminal provided rapid, secure and convenient portable access to PACS images and the image quality was sufficient for diagnostic interpretation of ultrasound images of the thyroid.