Current use of medical imaging is far from satisfactory in terms of cost/effectiveness. To improve this, it is necessary to use database techniques. Different from a digital archive, a medical image database is capable of information abstraction, inferencing and reasoning. We will review current research and techniques world-wide, especially, the KMeD system developed in UCLA. We then address various issues in the development of medical image databases and present our work in the field. Many issues are also general concerns in medical imaging such as filtering, segmentation, registration, clustering, compression, reconstruction and visualization.