Hospitals are investing in Information Technology and Information Systems in order to improve their processes and workflow and hence, to optimize patient care. Picture Archiving and Communications Systems (PACS) have seen gradual uptake in hospitals to achieve this goal. PACS implementations and the consecutive expansion and integration with the Electronic Patient Record requires massive investments and cultural changes by hospital (clinical) staff prior and during organizational adoption. It is therefore essential that these systems are aligned properly with the hospital operations. Alignment approaches for PACS implementations and appropriate assessment methods have been underexposed in scientific literature. In this paper, we propose the PACS integrated situational alignment (PISA) Framework, a theoretical framework that is designed for the continuous assessment, monitoring, successful alignment of PACS, and performance measures for PACS deployment in the hospital enterprise. In addition, we set out a research agenda to elaborate on this elementary topic.