Optics has had significant impact in the development and implementation of medical acoustic imaging. Principles of optical systems theory and optical instrumentation have played an important role in the conception, design and development in new ultrasonics research tools for diagnostic imaging and tissue character-ization; this is exemplified in the paper with a few acoustic imaging systems. A potential imaging system whose success relies on the interface between the optical subsystem and the acoustic subsystem is described. This system would have the advantage of operational flexibility and electronic simplicity. The present obstacles and possible solutions are discussed.