A significant problem in building large-scale picture archiving and communications systems (PACS) is the production of reliable and accurate software, within a specified amount of time and cost, without impacting existing operations. PACS software management is particularly difficult because most PACS involve highly distributed processing over very heterogeneous components. We applied total quality management techniques to the problem of PACS software management. All potential users of PACS software were identified as `customers,' and we optimized the quality of service provided to them. Our methodology involves each of these customers at each stage of the software development cycle to help ensure that PACS functions meet the requirements and priorities of the majority of PACS users. We used this approach in rewriting major sections of key software modules in the UCLA PACS, resulting in code development within predictable periods of time at a predictable cost, thus enhancing our software development cycle.