Images generated during the course of patient evaluation and management are an integral part of the medical record and must be retained according to local regulations. Digital Imaging and Communications in Medicine (DICOM) makes it possible for images from many different imaging modalities to be distributed via a standard internet network to distant viewing workstations and a central archive in an almost seamless fashion. The DICOM standard is a truly universal standard for the dissemination of medical images. Picture Archive and Communication System (PACS) refers to the infrastructure that links modalities, workstations, the image archive, and the medical record information system into an integrated system, allowing for efficient electronic distribution and storage of medical images and access to medical record data. This paper discusses the important elements to a successful PACS implementation in a practice, including how it interacts with other practice computing systems.