Objective To review the rapid evolution of imaging informatics dealing with issues of management and communication of digital images starting from the era of simple storage and transfer of images to today's world of interactive navigation in large sets of multidimensional data. Methods This paper will review the initial concepts of Picture Archiving and Communication Systems (PACS) and the early developments and standardization efforts that lead to the deployment of large intra-institutional

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... works of image distribution allowing radiologists and physicians to access and review images digitally. With the deployment of PACS came along the need for advanced tools for image visualization and image analysis. Results Review of the history of PACS and Imaging Informatics clearly shows that the early developments were focused on the radiologist's requirements for diagnosis and image interpretation. These early developments lagged behind the rapid adoption of digital imaging in areas outside radiology. Only recently, imaging informatics shifted toward the development of new tools geared toward the needs of other users such as surgeons, referring physicians and care-providers, and even for the patients themselves. Also in the recent years, the development of multimedia and communication tools in the consumer market has influenced the design and strategic development of image management platforms inside and outside healthcare institutions. Conclusions The focus of imaging informatics has clearly shifted in the last decade from basic infrastructure design to complete data and image navigation systems. While the challenge of storing and managing large volumes of imaging data have slowly vanished with the rapid development if information technology, the new challenge emerged from the new requirements of image manipulation and analysis in clinical practice.