In this paper we present initial work on the design and implementation of an image database system for medical images. The objective of this project is the development of an environment that will permit the quick and intelligent access of images using their content. An image database is a complex system consisting of many components that must be unified and integrated. These are the image analysis component that derives a representation of the stored images, the database component, and the user interface component. This paper focuses primarily on the justification of the design decisions, an illustration of the major features of such a system, and a requirements definition for its implementation. An object-oriented approach is proposed which meets these requirements. The capabilities of an object-oriented data model are demonstrated and possible extensions, needed to meet the data modeling requirements, are discussed.