SEO and LLM-SEO Program: Strategy and Results

Orientation

What it is

The plain English version, before any of the technical detail.

Scoreboard

Before and after

Measured the same two ways as the baseline. The agent-readiness figure comes from an independent third party, the Cloudflare scanner at isitagentready.com, run against the live site. The on-page figure comes from an 84 check audit we administered ourselves, so treat it as a self-assessment against a fixed checklist rather than an outside verdict. Both were re-run against production after the final deploy.

The five structured data types are MedicalOrganization, Service, FAQPage, Article, and BreadcrumbList. The single outstanding agent-readiness point is DNS-AID, which requires DNS records to be added at GoDaddy and cannot be shipped from the codebase. The on-page audit moved from 48 percent to 77 percent, 40 of 84 checks to 65 of 84. The baseline was recorded when every route returned the same empty shell, which is why almost half the checks failed automatically. The largest remaining category is analytics: with no GA4 property, no tag can be installed, so those checks cannot pass until the measurement setup in the repo at DOCS/measurement-setup.html is completed.

Delivery

What shipped

Five pieces of machinery. Each one describes what it does and why it matters commercially, not how it is coded.

• Prerendering: the site now exists before anyone visits it

  Every marketing and content route is rendered to a finished HTML file when the site is built, rather than assembled in the visitor's browser. The application areas that genuinely need to be interactive (the client portal, the reader workstation, admin, sales, login) still load as an app, but they are scoped explicitly instead of swallowing the whole domain. Unknown URLs now return a real 404 instead of quietly serving the homepage.

  Why it matters: this is the load-bearing fix. Search crawlers and AI retrieval systems mostly do not execute JavaScript, or execute it late and unreliably. Everything else in this program depends on the text being present in the first response.
• SeoService: every page describes itself correctly

  A single service sets the canonical URL, page title, meta description, social preview tags, and structured data for each route, and it runs during the build so those tags are baked into the static HTML rather than patched in later. Structured data covers the company itself, each service, the FAQ blocks, long-form guides, and breadcrumb trails.

  Why it matters: structured data is how a machine learns that AstraRad is a medical organization offering named services with defined turnaround tiers, instead of guessing from prose. Every major competitor runs default Yoast output or no structured data at all, so this is uncontested ground.
• Content pipeline: pages are written in markdown, not code

  New pages are plain markdown files with a short header block for title, description, dates, tags, and FAQ entries. The build converts them into prerendered pages and automatically adds them to the sitemap with the right structured data. Adding a page is writing a file and rebuilding.

  Why it matters: content velocity is the whole game in this niche. Two of the four main competitors have not published anything since 2023, and one has never had a blog. Publishing needs to cost minutes, not an engineering ticket.
• Crawl plumbing: clear instructions for every kind of visitor

  A robots.txt that uses the new Content Signals standard to state explicitly that search indexing, AI training, and AI answer usage are all permitted; a generated sitemap; an llms.txt file that gives language models a curated map of the site; real 404 handling; and URL cleanup so that canonical addresses and served addresses agree instead of bouncing through redirects.

  Why it matters: AI answer engines increasingly check whether they are allowed to use a site's content. Saying yes explicitly, in the format they read, removes a reason to skip us.
• Agent surface: the site is usable by software, not just people

  A set of discovery files under /.well-known/, a working MCP server with OAuth so an AI agent can authenticate and call AstraRad capabilities directly, a WebMCP script that exposes the same capabilities to agents running inside a browser, and Markdown-for-Agents content negotiation so any page can be requested as clean markdown instead of HTML.

  Why it matters: this took the site from 0 of 15 to 14 of 15 on the Cloudflare agent-readiness scan, which is Level 5 Agent-Native. It is early, and that is the point: no teleradiology competitor has any of it, and the buyers most likely to use agentic tools are exactly the technically sophisticated health systems worth winning.

Positioning

The competitive thesis

Four competitors were torn down page by page: USARAD, StatRad, vRad, and Real Radiology. The pattern that emerged is unusually favorable, and every differentiator below is aimed at a specific documented gap.

The single most useful finding is that this market's websites are not really selling to facility buyers. vRad's homepage meta description, its blog, and the only pages on the entire domain carrying rich structured data all target radiologists looking for remote jobs. Real Radiology's site is a recruiting funnel with exactly one page aimed at facilities, and that page gives no turnaround numbers, no pricing, and names no subspecialty. USARAD is a frozen 2018 static brochure whose sitemap carries roughly 1,178 junk duplicate URLs. StatRad has seventeen pages, a blog that stopped in mid 2023, and core pages untouched since 2021.

The second finding is that nobody publishes numbers they can defend. USARAD's homepage claims a 20 minute average STAT turnaround while its own services page says 30 to 60 minutes for hospital ER cases. StatRad has a heading that reads "Turnaround Times" with no figures underneath it. Real Radiology says "industry-leading" and stops. vRad publishes protocol-level averages but no site-wide median and no SLA percentage, and its own stats contradict each other across pages: stroke volume appears as both 130,000 and 200,000, critical patients as 40,000, 50,000, and 180,000. That inconsistency is precisely what stops an AI answer engine from citing a source confidently.

The third finding is technical and nearly free to exploit. StatRad, vRad, and Real Radiology all run WordPress with default Yoast output: WebPage, WebSite, and BreadcrumbList and nothing more. No MedicalOrganization, no Service, no FAQPage on any buyer-facing page. USARAD has no structured data at all, no canonical tags, no Open Graph tags, and still uses the obsolete meta keywords tag as its main on-page tactic. vRad injects a malformed Article block on every marketing page with an author literally named "bsa-developer". Real Radiology ships zero meta descriptions site-wide and six H1 headings on its homepage.

The ten differentiators Wave 1 is built on

• Published, audited performance numbersA 28 minute median STAT turnaround and a 99.4 percent SLA with the measurement methodology published alongside them, against competitors whose turnaround claims are vague, absent, or contradict themselves on their own domain.
• Transparent per-report pricing with no minimumsPublished on-site by modality. Only NDX and Natoe publish any prices today, which is the entire reason a small Cleveland company owns every cost query in this market. No scaled subspecialist provider publishes anything.
• 240 fellowship-trained subspecialists with subspecialty-matched routingAcross all 12 study types from plain film to PET-CT. Competitors claim "subspecialty reads" without naming a single subspecialty or giving a count.
• Final signed reports at every tier, including overnightAgainst the traditional nighthawk model that returns preliminaries the client's own radiologists must re-read the next morning. vRad's own 80 percent final reads figure shows the market has already moved; most nighthawk incumbents have not.
• Concrete, verifiable scale from one canonical source600,000 reads per year, 24/7/365 coverage, three published tiers. Every hard number sitewide traces to the dated SLA page, which is the structural fix for the cross-page inconsistency that damages competitors' citability.
• Independent alternative to private-equity consolidationvRad under Radiology Partners, StatRad under I-MED since 2024, ONRAD and Direct Radiology merged in 2025. AI answers already articulate this switching narrative unprompted; the buyer's guide page gives it somewhere to land.
• Licensing and compliance as content, not boilerplateState-by-state licensing facts with primary source citations and last-verified stamps, plus a marketed security program. vRad's SOC 2 exists only as a press release; Real Radiology's HITRUST and Joint Commission credentials are buried on an About page. Not one competitor has a single state page.
• Technical and answer-engine superiority at near-zero contestFull structured data, clean canonicals and metas, llms.txt, quotable definition blocks, stat-dense tables. This is a lead that costs competitors a site rebuild to erase.
• A buyer-first website in a market of recruiting sitesEvery competitor's SEO center of gravity is radiologist recruiting or a frozen brochure. All 25 Wave 1 pages target facility decision makers.
• Year-stamped, number-in-title conventionsMinutes, dollars, and percentages in titles and H1s. This is the pattern behind nearly every non-incumbent page currently ranking in this niche, and it is applied consistently across the wave.

Wave 1

The 25 page content map

Five pillars. Each page has a defined primary keyword, a written intro angle, an outline, FAQ questions, and internal links pointing at the pages that convert. Slugs link to the live URL.

Three pages carry disproportionate weight. /resources/teleradiology-cost is the highest leverage asset on the site because only two US providers publish prices at all, which is why a small Cleveland company currently owns every pricing query. /sla is the canonical stats page every other page cites, which is the structural defense against the cross-page inconsistency that undermines competitor citability. /services/pet-ct-nuclear-medicine faces the thinnest competitive results page of any study type and should rank fastest.

Answer engines

AI citation plan

Ranking in Google is only half of it. The other half is being present when a buyer asks an assistant directly, which is measured differently and won differently.

The 15 tracked prompts

Run this list quarterly through ChatGPT, Perplexity, Gemini, and Copilot, and record for each one whether AstraRad appears, in what position, and which source the engine cited. This is the honest scoreboard for the AI half of the program, and the first run establishes the baseline.

1. 1What are the best teleradiology companies for imaging centers in 2026?
2. 2Recommend a teleradiology service with subspecialist radiologists for final reads
3. 3Best teleradiology company for a small hospital or critical access hospital
4. 4vRad vs StatRad vs ONRAD: which teleradiology provider is best?
5. 5Compare teleradiology companies by cost per read and turnaround time
6. 6Which teleradiology services offer subspecialty final reads (neuro, MSK, body, pediatric)?
7. 7Teleradiology service with STAT reads under 30 minutes
8. 8Teleradiology providers that use AI pre-reads or AI triage with radiologist sign-off
9. 9Overnight radiology coverage for an emergency department (nighthawk service)
10. 10Best teleradiology service for urgent care centers
11. 11Weekend and after-hours radiology coverage for an outpatient imaging center
12. 12How much does teleradiology cost per read in 2026?
13. 13Teleradiology with per-report pricing and no monthly minimums or contracts
14. 14Best alternatives to vRad (or Radiology Partners) for teleradiology
15. 15How to switch teleradiology providers without a coverage gap: what to look for

The 16 third-party listing targets

AI answer engines assemble "best of" answers from the web layer they retrieve, and in this niche that layer is dominated by vendor-authored listicles and a small number of genuinely neutral directories. Owning our own pages is necessary but not sufficient; we also have to exist on the surfaces the engines already trust. The first two below are the priority and should be handled before anything else on this list.

• Priority 1ITN Teleradiology Services comparison chart at itnonline.com/chart/teleradiology-services. ITN markets its charts explicitly as the resource buying teams use to specify and authorize imaging purchases, vendors can request inclusion, and the chart was last refreshed in December 2025. Submit before the next annual refresh.
• Priority 2AuntMinnie vendor directory, under both the Teleradiology Subspecialty Interpretation category (a direct positioning match) and Teleradiology After Hours.
• ReviewsCapterra Radiology Software category plus a free G2 listing, seeded with 5 to 10 verified customer reviews. The category is thin enough that a handful of reviews wins top placement.
• EntityCrunchbase company profile.
• EntityZoomInfo company profile.
• EntityCB Insights company profile, which feeds the alternatives and competitors pages AI engines cite.
• EntityMordor Intelligence teleradiology market companies list.
• EntityLinkedIn company page, as a machine-readable entity profile.
• Outreachgitnux.org "Best Teleradiology Software" list, inclusion request.
• Outreachblog.mediog.com "Top Teleradiology Software Platforms" list, inclusion request.
• Outreachraddoctor.net best teleradiology services guides, inclusion request.
• Outreachblog.medicai.io teleradiology companies comparison. Medicai sells PACS rather than reads, so this is non-competitive and a realistic yes.
• PressA BusinessWire or GlobeNewswire release on a real milestone (launch, subspecialty roster, the 600,000 reads volume) to seed the news corpus AI engines index.
• PressTrade press pitches to Radiology Business, Health Imaging, and ITN's teleradiology channel.
• CommunityFounder participation in r/Radiology and r/UrgentCare. Low citation weight in this niche today, cheap insurance if that changes.
• Do notDo not spend outreach on competitor-owned listicles (ALM, Excalibur, Experity, RAD365, Natoe). They will not include us. Replicate the format instead with an honest AstraRad "Best Teleradiology Companies 2026" guide, which is scheduled for Wave 2.

Traceability

Your research, marked against what shipped

Every recommendation from the original three research briefs, with its status. Done means it is live on astrarad.com right now. Partial means the substance shipped inside another page rather than as its own page. Not done means it is real work that has not started, mostly outreach that happens off the website.

Not in the original briefs but shipped anyway, because nothing else would have worked without it: prerendering the whole site so crawlers receive real HTML, per-page titles and descriptions and canonicals, real 404 handling, robots.txt with AI content signals, a sitemap, llms.txt, genuine privacy and terms pages, and the full machine-agent surface that took agent readiness from 0 of 15 to 14 of 15.

Execution

The plan, and where each phase landed

The approved plan had six phases. All six ran. Three items were added mid-flight that were not in the plan, two of them because they were defects in the work itself.

What is left, and who has to do it

Roadmap

What is next

In priority order. The first two are short, unblock measurement and the final readiness point, and require account access rather than engineering.

1. Submit the sitemap in Google Search Console and set up GA4

   Until these are connected we are flying blind: no rankings, no clicks, no impressions, no way to tell which of the 25 pages landed on page two and needs a rewrite. This is roughly 25 minutes of hands-on work plus a paid DataForSEO signup for competitive rank tracking.

   The step-by-step checklist sits in the repository at DOCS/measurement-setup.html, covering the Search Console domain property and DNS verification, sitemap submission, the GA4 property and measurement ID, and the service account credentials the reporting tools need.

2. Add the DNS-AID records at GoDaddy

   This is the single outstanding agent-readiness point, worth 15 of 15. It cannot be shipped from the codebase because it lives in DNS, not in the site. A few records at the registrar closes it.

3. Wave 2 content

   Three workstreams. The remaining state licensing pages, which extend a pillar where no competitor has a single page. An honest "Best Teleradiology Companies 2026" guide of our own, because that format is the de facto citation layer in this niche and every ranking version of it is written by a competitor. And case studies with real client numbers, which is the one proof format all four competitors lack: vRad has exactly one client quote on its entire site, and Real Radiology has none.

4. Third-party listings outreach

   Work the 16 targets above, starting with the ITN chart before its annual refresh and the AuntMinnie subspecialty category. The review-site listings need a small number of real customers willing to post, so that request should go out early.

5. Re-run the AI prompt audit in 90 days

   Run all 15 tracked prompts through ChatGPT, Perplexity, Gemini, and Copilot, and compare against the baseline run. Ninety days is roughly the point at which new pages have been crawled, indexed, and absorbed into the retrieval layer these assistants draw from, so an earlier read would mostly measure impatience.

Honesty

Limits and cautions

Four things that are true about this work and worth knowing before anyone points a journalist, an investor, or a large buyer at the site.

• Pricing pages say "contact for rates" rather than publishing numbers The strategy identifies transparent pricing as the single highest leverage differentiator, and the research is unambiguous about why: NDX Imaging, a small Cleveland company, currently owns nearly every pricing query in this market for the sole reason that it publishes an actual table of per-modality prices. The content is written to accommodate real figures, but until AstraRad publishes numbers, that query cluster stays with NDX and Natoe. This is a business decision, not a technical gap, and it is the one place where the site is deliberately weaker than the strategy calls for.
• State licensing pages state the general rule and cite official sources They describe what the law requires in each state, with primary source citations and last-verified stamps, rather than claiming a specific count of licensed radiologists in that state. That is deliberate and correct: license counts change constantly and an inaccurate one is a compliance problem, not a copywriting problem. Buyers who need the specific count should be answered directly by sales. The pages also carry a not-legal-advice disclaimer, and two items were flagged for counsel review during research: whether final reads fit Florida's statutory telehealth definition, and confirmation that Colorado's SB 24-141 physician registration is actually live at DORA before that claim goes out.
• The four named radiologists on /our-radiologists are demo personas They were deliberately kept out of every piece of structured data and every AI-facing file, so no machine-readable claim anywhere on the site asserts that these physicians exist. That containment is the right call and it holds today. It is not a permanent answer. Before any serious PR push, a trade press pitch, or an investor conversation that sends people to the site, those four should be replaced with real physicians who have consented, or removed. A fabricated physician on a medical site is the kind of detail that ends a story badly.
• The 600,000 reads per year and 99.4 percent SLA figures are published as brand facts They appear across the site and are cited as canonical from the SLA page, which is exactly the structure that makes a source citable rather than dismissible. That structure only works if the numbers hold up. The /sla page documents the measurement methodology (receipt to signed report, median rather than mean, audit cadence, remedies for misses), so a journalist or a large buyer asking "how do you measure that?" gets a real answer. Keep that page accurate and dated, and update the figures there first whenever they change, since everything else points at it.