PACS systems are constantly changing following the pace of changes in the IT industry. The life expectancy of PACS is much shorter than that of other medical imaging equipment. Despite healthcare institutions’ or enterprises’ desire for IT systems stability, typically in 3-5 years, institutions face a major upgrade requirement. PACS/RIS or other department information system vendors also prefer their customers to upgrade their latest software release to streamline their responsibility of service and support. Additionally, PACS has been around long enough that healthcare institutions may want to replace legacy or current PACS systems. The issues institutions or enterprises face when upgrading on switching to different PACS/RIS are quite different from those faced when PACS is implemented for the fi rst time, especially when the replacement system is from a different vendor.