Medicine is a visual discipline. In the Practice of medicine, physicians require many forms of visual information to successfully conduct their tasks of diagnosing the presence or absence of disease; evaluating the progression or remission of disease; developing strategies for individual patient treatment planning; and in educating their peers and students. Thus, today's hospitals must provide an effective management strategy for a variety of medical images. This management strategy includes the functions of the acquisition of patient images, the archiving of patient images, and the storage of patient images. In a hospital, each medical specialty generates a class of visual images from which information is extracted for use by the patient's physician. This paper will address four issues in the use of medical images in today's hospitals. First, an estimate of the sources and utilization of clinical images in a hospital will be presented. Second, estimates will be provided regarding the magnitude of each of these images sources. Third, current management strategies for dealing with these images will be reviewed. Fourth, several potential solutions will be described for improving the management and archiving of these image sources in a hospital environment.