The DICOM standard (Digital Imaging and Communications in Medicine) has been developed in order to obtain compatibility at the higher OSI levels. This paper describes the implementation of DICOM into our developed low cost PACS, which uses as much as possible standard software and standard protocols such as SQL, X Windows and TCP/IP. We adopted the requirement that all messages on the communication network have to be DICOM compatible. The translation between DICOM messages and SQL commands, which drive the relational data base, has been accommodated in our PACS supervisor. The translation takes only between 10 and 20 milliseconds. Images, that will be used the current day are stored in a distributed, parallel operating image base for reasons of performance. Extensive use has been made of X Windows to visualize images. A maximum of 12 images can simultaneously be displayed, of which one selected image can be manipulated (e.g., magnified, rotated, etc.), without affecting the other displayed images. The emphasis of the future work will be on performance measurements and modeling of our PACS and bringing the results of both methods in agreement with each other.