PACS pitfalls are mostly created from human error, whereas bottlenecks are due to imperfect design in either the PACS or image acquisition devices. These drawbacks can only be realized through accumulated clinical experience. Pitfalls due to human error are often initiated at imaging acquisition devices and at workstations. Three major errors at the acquisition devices are entering wrong input parameters, stopping an image transmission process improperly, and incorrect patient positioning. The error occurring most often at the workstation happens when the user enters too many key strokes or clicks the mouse too often before the workstation can respond. Other pitfalls at the workstation unrelated to human error are missing location markers in a CT or MR scout view, images displayed with unsuitable look-up-tables, and white boarders in CR images due to x-ray collimation. Pitfalls created due to human intervention can be minimized by a better quality assurance program and periodic in-service training, and by interfacing image acquisition devices to the HIS/RIS. Bottlenecks affecting the PACS operation include network contention; CR, CT, and MR images stacked up at acquisition devices; slow response from workstations; and long delays for image retrieval from the long term archive. Bottlenecks can be alleviated by improving the system architecture, re- configuring the networks, and streamlining operational procedures through a gradual understanding of the clinical environment. We have identified most of the pitfalls and bottlenecks discussed above in our hospital-integrated PACS based on the past two years of clinical experience. This paper categorizes some of these problems, illustrates their effect on PACS operations, and suggests methods for circumventing them.