The authors review the potential of picture archiving and communication systems (PACS) in the critical care environment. Presented and analyzed is a university hospital intensive care unit (ICU) PACS project. The objective of the project is to provide reliable, timely viewing of bedside radiographs in selected ICUs within the hospital. Key features include redundancy of critical hardware components and viewing stations that are simple to operate. The system was implemented in phases with incremental evaluation of performance and goals. PACS subsystems are discussed. On the basis of this experience, ICU PACS specifications and general considerations are presented. Also presented is a comparison of 10-year cost projections for conventional screen-film radiography and an ICU PACS that incorporates computed radiography. The costs of the two alternatives are comparable. PACS is a viable alternative to conventional screen-film imaging in the ICU setting and offers improved and more efficient patient care.