The evidence published to date is insufficient to provide definitive answers to the critical questions posed about the use of PACS in a clinical setting. Although data do suggest that the technology is improving, it has not yet been clearly demonstrated that PACS workstation imaging is equivalent to conventional film for the accurate primary diagnosis of all of the types of illnesses that present in the veteran population. Limited available data do suggest that some work processes are performed more rapidly in a PACS environment. It remains to be demonstrated that overall clinical and production processes are more efficient, or that those efficiencies translate into improved quality, increased access, or reduced cost of care. High quality studies of effectiveness, outcomes, and cost benefit are still needed.