Medical imaging companies have traditionally supplied the industry with image visualization solutions based on their own custom hardware designs. Today, more and more systems are being deployed using only off-the-shelf workstations. Two major factors are driving this change. First, workstations are delivering the functionality and performance required to replace custom hardware for an ever increasing subset of visualization techniques, while continuing to come down in cost. Second, cost pressures are forcing medical imaging companies to OEM the hardware platform and focus on what they do best -- delivering solutions to health care providers. This industry shift is challenging the workstation vendors to deliver the maximum inherent performance in their computer systems to medical imaging applications without locking the application into a specific vendor's hardware. Since extracting the maximum performance from a workstation is not always intuitively obvious and often requires vendor-specific tricks, the best way to deliver performance to an application is through an application programmer's interface (API). The Hewlett-Packard Image Visualization Library (HP-IVL) is such an API. It transparently delivers the maximum possible imaging performance on Hewlett-Packard workstations, while allowing significant portability between platforms. This paper describes the performance tricks and trade-offs made in the software implementation of HP's Image Visualization Library and how the HP Image Visualization Accelerator (HP-IVX) fits into the overall architecture.