The transformation from film-based to filmless operations has become more and more challenging as medical imaging studies expand in size and complexity. To adapt to these changes radiologists must actively develop new workflow strategies to deal with increasing work demand. This article addresses the evolutionary changes underway in the radiology interpretation process, reviews shifts that have occurred in the past years and presents our departments experience with an open source radiological information system based on IHE (Integrating Healthcare Enterprise) directives. These undergoing changes include a number of development in soft-copy interpretation, electronic decision support and learning tools such as MIRC (Medical Imaging Resource Center).