At the end of December 1998, the traditional clinical slide library at the Media Resources Centre University Hospital of Wales and University of Wales College of Medicine was closed to new acquisitions. This paper describes how a digital image database (Image AXS) has been customized to provide a source of rapidly accessible and easily searchable images, suitable for teaching and reference purposes. The basic functions of the program are explained and areas such as data integrity, image capture, storage, archiving and the impact that this technology has had on departmental workflow are discussed.