The project will examine the computer and paper-supported co-operation, CSCW (Computer Supported Cooperative Work) and 'PSCW' ('Paper Supported Cooperative Work') respectively in connection with requisition and reply handling in the Image Diagnostic department of the Region Hospital Viborg, Denmark. A decision has been taken regarding abolishing this paper support by the end of 2007. Method On the basis of literature studies of the CSCW-research field and of the cultural theory we have carried out a detailed observation study of the paper flow of printed requisitions which takes place parallel with the electronically workflow in the x-ray information system Syngo - RIS. We have supplemented with a limited specification (one working day) of added comments on the requisition print and with qualitative interviews with different professionals in the department. Results Our results show that the printed requisitions serve different functions regarding control and adjustment of the planned RIS-workflow. The results are here in line with similar findings regarding CSCW-systems on other locations. Our findings indicate that the department culture is influenced by many years of ongoing technological development but it is still found to be positive to changes and computer technology. Discussion An abolition of the paper flow makes extra demands on RIS functionality, implementation of which we do not consider to be possible in short terms. We expect that the users due to the department culture - will be willing to carry the extra burdens, but anyhow the flow will be less efficient in this period. This cost must be compared to the benefit of 100% electronically availability of the documentation.