The use of a Digital Radiography system (DR) with a digital interface to a PACS, greatly increases the potential of the system for effective communications, since it makes the majority of the cases done in the radiology department available without the need to digitize film. The new all digital, fully integrated system, consisting of a DR system and a PACS has been installed in the Duke University Medical Center Radiology Department. The digital radiography system, Philips Computed Radiography (PCR), transmits images to the PACS (CommView) via a PACS Interface Processor (PIP). The questions and problems associated with the integrated system are now being investigated. © SPIE.