Real-time consultation between referring physicians or radiologists with an expert is critical for timely and adequate management of problem cases. During consultation, both sides need to (1) synchronously manipulate high resolution digital radiographic images or large volume MR/CT images, (2) perform interpretation interactively, and (3) converse with audio. We present a specific designed teleconsultation system with hi-directional remote control technology to meet critical teleconsultation application with high resolution and large volume medical images in a limited bandwidth network environment. We give the system design and implementation methods, and also describe the teleconsultation procedure and protocol used in this system. Finally, preliminary results are discussed.