The concept of PACS was initiated in 1982 during the First International Conference and Workshop on Picture Archiving and Communication System, held in Newport Beach, California, January 1982, sponsored by SPIE. During the past seventeen years, many large and small PAC systems have been installed and are running smoothly. Around the world, many more systems will be planned and installed for years to come. This paper describes the author's personal PACS implementation experience including in-house development, partnership with manufacturers, and participation as a member of the advisory board in both the hospital and the manufactures. In the latter case, three examples are described for a very large urban hospital, a small community hospital, and a PACS manufacturer in the Far East. Lessons learned from each case are given.