Certain examples provide systems and methods for medical diagnostic collaboration. An example medical collaboration system includes an imaging service manager to provide a first device access to images from a database in response to a request received, the images to be viewed at the first device as first images; a collaboration server to access a request to initiate a conversation between the first device and a second device, in response to the conversation being initiated between the first device and the second device, the collaboration server to generate a study identifier that describes a viewport hanging protocol of the first images at the first device; a conversation manager to: access the images from the database in response to the second device launching the study identifier, the images to be viewed at the second device as second images; organize the second images based on the viewport hanging protocol; and enable the second images to be viewable at the second device to enable real-time collaboration between the first device and the second device.