The RIS became a thing before the PACS as digital imaging arrived later in the piece. They should always have been integrated, as many things are clumsy when spread across two systems. Some ‘reports’ are an image (eg vessel mapping and many cardiac reports). Some imaging doesn’t require a written report (theatre screening for implant placement). Some imaging requires multiple reports (a cardiac CT scan which covers lungs often gets a radiology and cardiology report). Some imaging is done to aid the acquisition of a different type of imaging. All these scenarios are handled in various clumsy ways by the various system and work around workflows are made up by staff on a near daily basis.