Abstract The ability to digitize images has led to the prospect of reducing the physical space requirements, material costs, and manual labor of traditional film handling tasks in hospitals. The system which handles the acquisition, storage, and transmission of medical images is called a Picture Archiving and Communication System (PACS). One of the most important components of a PACS is the network, which connects the various sub-systems of a PACS. Several high-speed networking technologies have evolved in the last decade, Asynchronous Transfer Mode (ATM) is one of them. This paper discusses some of the issues to be resolved for rapid and effective deployment of ATM into PACS. The work is useful in providing the latest information for any future research on ATM-based PACS.