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This paper deals with the development of standards in the field of medical imaging and picture archiving and communication systems (PACS's), and notably concerning the interworking between PACS's and hospital information systems (HIS). It explains, in detail, how a conceptual model of the management of medical images, such as the medical image management in an open system architecture (MIMOSA) model, can contribute to the development of standards for medical image management and PACS's. This contribution is twofold: 1) Since the model lists and structures the concepts and resources involved to make the images available to the users when and where they are required, and describes the interactions between PACS components and HIS, the MIMOSA work helps by defining a reference architecture which includes an external description of the various components of a PACS, and a logical structure for assembling them. 2) The model and the implementation of a demonstrator based on this model allow the relevance of the Digital Imaging and Communications in Medicine (DICOM) standard with respect to image management issues to be assessed, highlighting some current limitations of this standard and proposing extensions. Such a twofold action is necessary in order both to bring solutions, even partial, in the short term, and to allow for the convergence, in the long term, of the standards developed by independent standardization groups in medical informatics (e.g., those within Technical Committee 251 of CEN: Comite Europeen de Normalisation).