The goal of this research is to implement an extensible, user-friendly, portable and affordable medical image analysis environment that frees the analyst from having to deal with low-level programming issues. With this environment, the user can rapidly prototype, test, validate and statistically analyze new medical image analysis algorithms. The environment tightly integrates a medical image database that supports image content and metadata based querying; visualization and browsing of query results; S-Plus, a powerful object-oriented, interpreted programming environment, with a large suite of built-in visualization, data analysis, statistics and image processing tools. The system interfaces with any SQL-based relational database management system. The database schema is based on the DICOM standard. Using MedPlus, the user can develop image analysis procedures that integrate database queries, interactive image analysis, statistical inference and database archival of results using ether a scripting language.