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Telemedicine is a growing field and has to face various challenges like its integration to the medical practice and to the health care system, its economic implication and its social impact. This paper will focus on the technological aspects of telemedicine that will be first reviewed. Three main dimensions will be shown to structure the technological space of telemedicine: network, information processing and knowledge engineering. These three components will be briefly discussed. In a second part we will develop three specific issues addressing challenging image and knowledge engineering problems (multimedia medical image management, multimedia medical knowledge bases constitution and management, and case-based reasoning in diagnostic imaging and medical data mining).