Shortages in radiology services are estimated to affect 3.5-4.7 billion people worldwide. Teleradiology is a potential means of alleviating this shortage.This paper examines the practicality and sustainability of a pilot pediatric teleradiology project at the Khayelitsha District Hospital in sub-Saharan Africa. We analyze how this World Federation of Pediatric Imaging (WFPI) program fares against the global challenges described in the current literature facing these practice types.A teleradiology pilot was developed to provide coverage to the Khayelitsha District Hospital after the district pediatrician requested assistance in interpreting radiographs. This program utilized a network of WFPI volunteer pediatric radiologists, direct JPEG conversion of digital radiographic images, and an e-mail delivery system of images, referral requests and teleradiology opinion. Data were collected retrospectively from referral cards and JPEG images of radiographs, as well as from the volunteer officer database.A total of 555 referral cards and 1,106 radiographs were submitted for teleradiology opinion during the course of this pilot program; 74.6% of requests for image interpretation were chest radiographs and 14.2% of those were for the evaluation of tuberculosis. There were 40 volunteer teleradiologists from 17 countries; all spoke English, and 14 were bilingual (8 fluent in Spanish, 5 in Portuguese, and 1 in Italian).Teleradiology is a viable option to alleviate radiologist shortages in underserved areas, but there are many challenges to designing an adequate teleradiology system. The WFPI pilot teleradiology program can be considered a successful one.