Medical image based collaboration system and methods are provided. A collaboration server 40 creates a medical image based case in response to a request from a requesting system 10 and populates the case with the minimum required information comprising at least a digital medical image and a case number. The collaboration server 40 provides the medical image based case to a consulting system 30 and receives analysis information in response. The collaboration server 40 stores the analysis information in association with the medical image based case and provides the analysis information to the consulting system 30 to complete the medical image based collaboration.