In this article the authors describe the Management Informatique de la Radiologie et de l'Imagerie Médicale (MIRIAM) major picture archiving and communication system (PACS) project in Paris, France. The Assistance Publique of Paris, France is a healthcare provider and took the initiative to start the largest PACS program in Europe to date. The MIRIAM project will start in 1997 and will be used in different, consecutive phases. A consortium of several companies is in charge of the implementation. Thirty-three hospitals with 54 imaging departments will be integrated in one system.