Of 1281 consecutive ED patients, 231 (18.0 %) had CXRs obtained, 320 CXRs were analyzed and 611 BBMs sent. All BBMs (100.0%, 95% confidence interval (CI) 99.4-00.0) arrived within two minutes; 595 BBMs (97.4%, 95% CI 95.8-98.4) were replied to within five minutes. Of the 58 CXRs with abnormalities requiring intervention, there were 55 concordances (overall agreement 94.2%, 95% CI 85.9-98.3; kappa 0.95, 95% CI 0.89-1.0) CONCLUSION: Systematic transmission of CXR images from a small ED to a remote large center using mobile phones may be a safe and effective strategy to rapidly communicate important patient information.