An economical and practical digital solution for the replacement of 35 mm cine film as the archive media in the cardiac x-ray imaging environment has remained lacking to date due to the demanding requirements of high capacity, high acquisition rate, high transfer rate, and a need for application in a distributed environment. A clinical digital image library and network based on the D2 digital video format has been installed in the Duke University Cardiac Catheterization Laboratory. The system architecture includes a central image library with digital video recorders and robotic tape retrieval, three acquisition stations, and remote review stations connected via a serial image network. The library has a capacity for over 20,000 Gigabytes of uncompressed image data, equivalent to records for approximately 20,000 patients. Image acquisition in the clinical laboratories is via a real-time digital interface between the digital angiography system and a local digital recorder. Images are transferred to the library over the serial network at a rate of 14.3 Mbytes/sec and permanently stored for later review. The image library and network are currently undergoing a clinical comparison with cine film for visual and quantitative assessment of coronary artery disease. At the conclusion of the evaluation, the configuration will be expanded to include four additional catheterization laboratories and remote review stations throughout the hospital.