The term picture archiving and communications system (PACS) was initiated during the first International conference and workshop on the topic sponsored by The International Society for Optical Engineering (SPIE) in Newport Beach, California in 1982. The research and development (R&D) progress for PACS has been slow until 1988. The earlier PACS modules were mostly off the shelf components connected together to solve a very specific clinical problem. The three major players in PACS R&D are the European countries, United States of America, and Japan. For various reasons, the European coun tries concentrated in modeling and simulation, U.S.A. pre ferred in-house development or purchased PACS modules from a manufacturer, whereas Japan organized the PACS as a national project. Between 1989 and 1990 PACS R&D took a dramatic positive turn. Large scale P ACS projects were planned and some are of implementation, especially in newly con at various stages structed hospitals. Examples are the Hokkaido University, Japan; Hammersmith Hospital, United Kingdom; Social and Medical Center East (SMZO), Vienna, Austria; the U.S. Armed Force Medical Diagnostic Imaging Support (MDIS) project; and the UCLA Medical Plaza ambulatory care center. Another phenomenon is the organization of the EC-countries which provides a tremendous impetus for the European PACS R&D efforts. This book "Hospital Integrated Picture Archiving and Communication Systems: edited by Professor M. Osteaux and others is a direct product from these efforts."

This volume contains the proceedings of the NATO Advanced Study Institute on "Picture Archiving and Communication Systems (PACS) in Medicine" held in Evian, France, October 14- 26, 1990. The program committee of the institute consisted of H.K. Huang (Director), Osman Ratib, Albert Bakker, and Gerd Witte. This institute brought together approximately 90 participants from 15 countries. These proceedings are the accumulation of eight years of research and development results in PACS by various dedicated groups throughout the world. The purpose of this institute was to review the most recent technology available for PACS and some clinical results. The readers should notice the remarkable advances in this field by comparing the contents in these proceedings with those in a previous institute on "Pictorial Information Systems in Medicine" held August 27 - September 7, 1984 in Braunlage/Harz, Federal Republic of Germany, and published as Vol. 19 in this series. The institute was organized according to four categories: PACS components and system integration, PACS and related research in various countries and manufacturing companies, clinical experience and research support, and participants' scientific communications. In PACS components, we included image acquisition, workstations, data storage and networking. In system integration, topics on interfaces between Hospital Information System (HIS), Radiology Information System (RIS) and PACS, clinical reports, the ACR/NEMA standard, databases, reliability, and system integration were discussed. This lecture series emphasized the technical detail and "how to" aspects.