The sheer amount of digital data generated by the proliferation of filmless medical imaging, poses great scalability and manageability challenges to PACS systems. Manageability challenges are aggravated when weighing legislative requirements. An architecture for an enterprise level PACS should support the management of assorted medical objects (e.g., images and reports). Additionally, the architecture should allow services, including performance and reliability, to be tailored to classes of objects according to complex and possibly varying rules. The design should be flexible, allowing for on-demand cost-effective scaling, using a mix-and-match selection of hardware, operating systems, and storage devices. In light of the increased reliance on stored data, it should ensure 24x7 availability, even during system upgrade, and allow pluggable support for future formats. The Medical Object Management System (MOMS) presented in this paper, is an enterprise medical imaging solution architectured to meet the above demands. Flexible, configurable and scalable content and source based management of objects enables administrators to define and modify policies that govern various aspects of the objects' life-cycles, using either configuration files or a Web-based GUI. The modular architecture of MOMS includes (possibly multiple) instances of interface (DICOM, HL7 and Tivoli Storage Manager), storage management and administration agents. Agent instances are hot-pluggable, allowing for zero-downtime upgrades, and can be deployed on a heterogeneous and distributed infrastructure. Leveraging the expertise gained in the development and deployment of the IDMR research PACS project, combined with recent technological advances and modern middleware, MOMS delivers a solution for the present and future requirements of medical objects management.