Examining the use of state-of-the-art technology to achieve filmless radiology, this work describes its impact on healthcare systems, thus providing insights into re-engineering healthcare. Sharing expertise developed in implementing picture archival and communications system technology capable of supporting filmless radiology, it relates the experiences of the Baltimore Veterans Administration Medical Center, the first site to have a fully-operational filmless radiology system. This is an overview of the subject, with advice on acquiring PAC systems. Also included are sections on its impact on the practice of radiology and the delivery of health care, clinical uses of computed radiography, technological issues, and case studies from both inside and outside the VA system.