Tokyo Hitachi Hospital, Hitachi Ltd., has used a hospital-wide PACS for over 1 year. The system runs a 100 Mb/s optical fiber network over the whole hospital including wards and outpatient clinic rooms, with 11 image workstations. The network links digital imaging modalities such as X-CT, MRI, computed radiography (CR) and digital radiography (DR) with a 2048 x 2048 (2k x 2k) matrix image intensifier television (I.I.-TV) system. These modalities generate about 200 images/day. The system has managed over 300,000 images of about 8000 patients so far. Although being still under improvement, the system has really been used for routine work. The hospital-wide PACS of a small hospital has been proved to be very useful for both image diagnosis and image management.