Hi,
reindexing requires reading all images and is typically not limited by the database speed. However, in principle, you should never have to reindex: it is only required when the database structure is updated or when the database is lost.
Packing the database removes deleted records from the dbaseIII tables. However, there should not be many in there (they only appear when you delete images from the server).
As far as the database is concerned, I now believe MySQL is the best choice for large installations. It can be installed on the same machine. There is an extensive database section in the windowsmanual document.
What particular operation do you want to speed up? The fastest read/write speed is probably obtained by saving the images (non-standard) as .V2, uncompressed or with NKI compression. Saving the images as .DCM is slower, and JPEG compression is particularly slow.
Marcel