It is apparent that digital radiography holds considerable promise. Although there are some immediate advantages to be gained from using digital technology at present, such as more consistent image quality in portable radiography, most of the benefits have not been fully realized. To do so requires a completely integrated digital radiology department using high-resolution video displays throughout the hospital connected to a large digital image archiving system. This concept, referred to as picture archiving and communication systems (PACS), represents the logical culmination of the extensive research that is continuing in this area. Because of the great expense involved, it is likely that the transition from conventional to digital radiography will be evolutionary in most medical centers, with establishment of local PACS networks initially, such as between the intensive care units and the radiology department. At a more basic level, limited digital radiography systems can function in isolation and address specific needs successfully. Although the science of computer-aided diagnosis is at an early stage, it seems likely that the sensitivity and specificity of these programs will continue to improve. Their eventual utility will depend on their accuracy and ease of use. The ultimate goal would be a relatively "transparent" multifaceted program that would screen all radiographs prior to interpretation to provide the radiologist or clinician with diagnostic suggestions and quantitative data. Given the present rate of progress in this area, such a concept is not unrealistic. However, even the most ardent enthusiasts do not envision totally independent computer-based interpretation of radiographic images for some time. Although digital image processing has not greatly improved diagnostic accuracy merely by enhancing the appearance of the radiographs, there are other potential diagnostic advantages in using digital images, such as rapid retrieval of previous examinations and the ability to correlate chest radiographs with CT or MRI studies rapidly on a video display. Direct image correlation with registration and superimposition has been achieved in the case of positron-emission tomography and MRI studies of the brain. For chest radiograph examinations, superimposition and subtraction of earlier radiographs to enhance the detection of interval change is being studied. The question of when digital chest radiography will replace conventional imaging is controversial. In a recent multiauthored review of this subject, it was estimated that digital chest radiography will replace conventional film radiography in at least 50% of large teaching hospitals by the turn of the century.(ABSTRACT TRUNCATED AT 400 WORDS)