Picture archiving and communication system (PACS): a progressive approach with small systems.

PACS represents the natural evolution from working with digital modalities (e.g. CT, US, MRI, CR) towards a global digital environment where the film based activities are progressively replaced by their digital counterpart. The advantages of the technique and the drawbacks of the first implementations are described, as well as the recent advances in terms of technology, architecture, medical integration and cost-effectiveness. The so called 'second generation' PACS concept is presented with its features: modular architecture, progressive implementation, multi-vendor environment, integration with the Hospital Information System, standardization. This approach is particularly suited for progressive implementation in an existing hospital, in contrast to the possible top-down construction of a filmless radiology department, as a project for a totally new hospital. The implementation into the university hospital AZ-VUB is described as case study.