Introduction: To examine the integration of artificial intelligence (AI) into Picture Archiving and Communication Systems (PACS) and assess its impact on medical imaging, diagnostic workflows, and patient outcomes. This review explores the technological evolution, key advancements, and challenges associated with AI-enhanced PACS in healthcare settings. Methods: A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science databases, covering articles from January 2000 to October 2024. Search terms included “artificial intelligence,” “machine learning,” “deep learning,” and “PACS,” combined with keywords related to diagnostic accuracy and workflow optimization. Articles were selected based on predefined inclusion and exclusion criteria, focusing on peerreviewed studies that discussed AI applications in PACS, innovations in medical imaging, and workflow improvements. A total of 183 studies met the inclusion criteria, comprising original research, systematic reviews, and meta-analyses. Results: AI integration in PACS has significantly enhanced diagnostic accuracy, achieving improvements of up to 93.2% in some imaging modalities, such as early tumor detection and anomaly identification. Workflow efficiency has been transformed, with diagnostic times reduced by up to 90% for critical conditions like intracranial hemorrhages. Convolutional neural networks (CNNs) have demonstrated exceptional performance in image segmentation, achieving up to 94% accuracy, and in motion artifact correction, further enhancing diagnostic precision. Natural language processing (NLP) tools have expedited radiology workflows, reducing reporting times by 30–50% and improving consistency in report generation. Cloudbased solutions have also improved accessibility, enabling real-time collaboration and remote diagnostics. However, challenges in data privacy, regulatory compliance, and interoperability persist, emphasizing the need for standardized frameworks and robust security protocols. Conclusions: The integration of AI into PACS represents a pivotal transformation in medical imaging, offering improved diagnostic workflows and potential for personalized patient care. Addressing existing challenges and enhancing interoperability will be essential for maximizing the benefits of AIpowered PACS in healthcare.

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