Asynchronous transfer mode (ATM) technology has been implemented within our radiology department's hospital-wide PACS as well as in a wide area network (WAN) connecting affiliated hospitals. This paper describes our implementation strategies and the network performance observed in a clinical setting. The image communication network for our PACS is composed of two network interfaces: ATM (OC-3, 155 Mbps) and Ethernet (10 Mbps). This communication network connects four major campus buildings and two remote hospitals, providing intra- and interbuilding communication for radiologic images including CT, MR, CR, US, and digitized screen-film images. The network links these modalities via their acquisition computers to the PACS controller and to display workstations. The ATM serves as the primary network for transmission of radiologic images and relevant data within the entire PACS. The standard Ethernet is used as a backup network for ATM. It interconnects all PACS components including radiologic imaging systems, acquisition computers, display workstations, the PACS controller, the database servers, and the RIS and HIS. Our communication network operates on a 24 hrs/day, 7 days/week basis. Performance of the ATM network was evaluated in terms of disk-to-disk, disk-to-memory, and memory-to- memory transmission rates. The average memory-to-memory transmission rate over the wide area ATM network was 8.3 MByte/s, which corresponds to transferring a 40-slice (or, 20- MByte) CT examination to a remote site in less than 3 seconds. With the emerging ATM technology, we believe that ATM-based digital communication network is a suitable choice for large-scale PACS involving both LAN and WAN.