Although trauma has been recognized as the third leading cause of death overall in the United States, it is the leading cause of death in persons less than 40 years of age. There are approximately 150,000 trauma deaths per year. About 50,000 of these occur on the highway, with victims suffering severe multiple system injury. For every death, 2-3 patients suffer major long-term disability. An important estimate states that one in four of these deaths could be prevented1. With this unfortunate fact in mind, trauma systems have been developed across the country over the past decade. A trauma system consists of 1) a sophisticated prehospital system with paramedics initiating resuscitation and rapid transport; 2) on-line communication networks linking prehospital personnel with physicians in trauma centers who provide medical control; and 3) the trauma center, which acts as the hub of the system by coordinating the prehospital efforts and providing definitive trauma care. The trauma center concept has been developed and defmed by the American College of Surgeons, which established three tiers: Levels I, II, and III, with the most severely injured patients being triaged to Level I institutions. Since death and major disability occur within a short time following injury in those patients, diagnosis and therapy must be both simultaneous and expeditious. This is accomplished by having surgeons--trauma surgeons, neurosurgeons, orthopedic surgeons and anesthesiologists--and operating room teams present in the hospital at all times. A level I trauma center recreates, in part or in whole, a hospital environment focused on a limited spectrum of disease. All the problems in medical care related to imaging that are experienced in the trauma center also exist throughout the remainder of the hospital system. However, due to the speed of health care delivery and the concentrated focus of multiple surgical subspecialists and radiologists on the same small number of medical images the problems become severely exacerbated. Virtually all of the most serious problems related to imaging in a level I trauma center can be resolved with digital acquisition and storage of conventional images combined with transmission of already digital images (CT scans) to a central display location. Additional benefits can be expected with the provision of remote access to images from intensive care units and operating rooms and rapid transmission of images to the ShockfTrauma section where the earliest and most intense medical care is administered. Consequently, a PACS system was installed at the Regional Medical Center at Memphis. Installation was completed in the first week of December, 1989 and the system is currently being phased into operation, and evaluated.