The suitability of computers to the task of medical image visualization for the purposes of primary diagnosis and treatment planning depends on three factors: speed, image quality, and price. To be widely accepted the technology must increase the efficiency of the diagnostic and planning processes. This requires processing and displaying medical images of various modalities in real-time, with accuracy and clarity, on an affordable system. Our approach to meeting this challenge began with market research to understand customer image processing needs. These needs were translated into system-level requirements, which in turn were used to determine which image processing functions should be implemented in hardware. The result is a computer architecture for 2D image processing that is both high-speed and cost-effective. The architectural solution is based on the high-performance PA-RISC workstation with an HCRX graphics accelerator. The image processing enhancements are incorporated into the image visualization accelerator (IVX) which attaches to the HCRX graphics subsystem. The IVX includes a custom VLSI chip which has a programmable convolver, a window/level mapper, and an interpolator supporting nearest-neighbor, bi-linear, and bi-cubic modes. This combination of features can be used to enable simultaneous convolution, pan, zoom, rotate, and window/level control into 1 k by 1 k by 16-bit medical images at 40 frames/second.