Teleradiology experiences from workstation to wireless technology and discrepancies from an “ideal world” of guidelines and a “real world” of medical practice are detailed. The real predictive value of Glasgow Coma Scale admission for the outcome of brain-injured patients and differences regarding the outcome of traumatic brain injury patients treated with or without neurosurgical facilities are outlined. Also examined is how to detect the computed tomography evolution before the neurologic change and the application of guidelines with area protocol and “hub and spoke” systems is discussed.