The aim of this study was to compare the degrees of implementations of full and departmental Picture Archiving and Communication Systems (PACS), the usage of mini-PACS and to compare digital image equipment implementation rates in the countries of the European Union plus the Czech Republic, Cyprus, Malta, Norway, Poland and Switzerland. The degree to which Digital Image Communications in Medicine version 3.0 (DICOM 3.0) protocols are available for data exchange by different digital image equipment is surveyed, to assess underlying PACS preparedness. A questionnaire with an addressed reply envelope was posted to the heads of radiology of 1594 hospitals in 19 countries in early 2000. Data returns were obtained from 17 countries. This indicates considerable variation in PACS implementation and preparedness between European nations. Possible reasons for this are discussed. The highest rates of PACS implementations have been in Austria, Norway and Sweden.