The purpose of this research and development effort was to solve several image management problems in Picture Archiving and Communications Systems (PACS). First, the patient and study information associated with images was not always correct and only rarely complete. This was due to human error in entering information on a console, and from incomplete data entry forms on image producing equipment. Second, in at least one area, Computed Radiography, the task of data entry was so time consuming that throughput suffered. The third problem was image routing, both within the Department of Radiology and throughout the hospital. The last identified problem was the lack of a common key between the PACS database the Radiology Information System (RIS) database so reports and images could be associated with each other. An RIS/PACS interface was developed in which RIS packets were sent to a PACS process at the time request forms were printed. These packets were parsed to various acquisition computers based on the modality type where they were stored in a MSQL Database for use in validating studies as they were completed prior to being transferred to PACS. DICOM header information from incoming studies were `matched' to a database entry based on the medical record number and modality. Whenever possible, an additional match was made on an accession number stored in the header. A match could result in the DICOM header being completed with detailed information about the patient, patient location, requesting service, and the procedure or study. In the case of the Kodak CR unit, patient and study information were sent directly to the CR workstation where they were accessible using a bar code interface at the time plates were ready to be processed. Routing within the radiology department was determined by comparing the RIS procedure code with an MSQL table to locate the workstation(s) used for viewing this type of study. The data of birth was used to determine whether the study should also be routed to a pediatric workstation. Finally, the accession number as assigned by the RIS was placed in the image header to allow matching of images and reports. The RIS/PACS system now matches patient, study, and other RIS information to PACS images to have improve routing, display, information accuracy, and efficiency. This system was built using a legacy RIS system without an HL7 interface, but the processes were created in a modular fashion that will make them easy to convert to HL7 when an expected new RIS is put in place. In order for a PACS to operate efficiently in an information intensive environment, the data associated with images must be correct, complete, and must contain `hooks' to other information systems in a medical center. The RIS/PACS interface is crucial to a successful PACS implementation.