Abstract: With the development and deepening of the reform of medical and health undertaken in our country, some problems and contradictions arose obviously during the orthopedic resident standardization training . It was very important to improve the ability of the orthopedic resident. With the aid of image storage and transmission system (picture archiving and communication System, PACS) in our research, we used the method of case Based Learning (case-shiller -based Learning, CBL) for orthopedic resident training reading ability. It was reflected in the form of a questionnaire survey of the teaching effect. The results showed that PACS can effectively improve learning interest and improve teaching efficiency by using training of clinical thought. In one word , better effects can be achieved by using PACS.