A 10 Mbits/second fiber-optic network for the transmission of chest x-ray images has been designed and implemented at our Hospital. Images are acquired with a high-resolution laser scanner. The viewing consoles display images at spatial resolutions of either 512 square or 1024 square. User interfaces have been designed to simplify the digitization and display processes. The applications level networking software and all the image processing software has been developed in-house. The system is now serving a 11-bed critical care facility on a day-to-day basis. This paper will focus on the software design issues. The software will be presented from a systems perspective. The importance of the user in the design process will be stressed and exemplified. The role of intelligent, rule-based software will be demonstrated. Selected clinical results will be discussed.