The authors address picture archiving and communications from the perspective of improving the communication of radiological information (images and diagnostic reports) between the radiologist and the client physicians. To that end, an experimental multimedia communication system (called IRIS) has been developed which supports the capture and distribution of digitized X-ray images and voice reports as integrated electronic patient folders. It also supports online consultation between the radiologist and physician by providing a multimedia shared space through synchronized workstation operation. In order to assess the clinical value and acceptance of these service concepts, the system is being deployed in the Ottawa Civic Hospital for a series of clinical trials. The authors describe the architecture and operation of the IRIS system and briefly discuss the first clinical trial, an emergency radiology link.