Objective We explored two strategies for query expansion utilizing medical subject headings (MeSH) ontology to improve the effectiveness of medical image retrieval systems. In order to achieve greater effectiveness in the expansion, the search text was analyzed to identify which terms were most amenable to being expanded. Design To perform the expansions we utilized the hierarchical structure by which the MeSH descriptors are organized. Two strategies for selecting the terms to be expanded in each query were studied. The first consisted of identifying the medical concepts using the unified medical language system metathesaurus. In the second strategy the text of the query was divided into n-grams, resulting in sequences corresponding to MeSH descriptors.