The continuing increase in diagnostic examinations using digitally formatted image instrumentation imposes new requirements on the acquisition, display, transmission, recording, and archiving of all diagnostic data. The fabrication decisions and initial clinical testing of a prototype on-line, decentralized digital image management system are described. With this system, raw digital data can be viewed by multiple users as soon as it is acquired by an acquisition node and transmitted to a display node. Radiologists and clinicians have given this system a favorable reception.