Computer-aided image analysis is becoming increas-ingly important to efficiently and safely handle large amounts of high-resolution images generated by advanced medical imaging devices. The development of medical image analysis (MIA) software with the required properties for clinical application, however, is difficult and labour-intensive. Such development should be supported by systems providing scalable computational capacity and storage space, as well as information management facilities. This paper describes the properties of distributed systems to support and facilitate the development, evaluation and clinical ap-plication of MIA methods. First the main characteristics of exist-ing systems are presented. Then the phases in a method s lifecycle are analysed (development, parameter optimisation, evaluation, clinical routine), identifying types of users, tasks and related computational issues. A scenario is described where all tasks are performed with the aid of computational tools integrated into an ideal supporting environment. The requirements for this environment are described, proposing a grid-oriented paradigm that emphasizes virtual collaboration among users, pieces of software and devices distributed among geographically dispersed heathcare, research and development enterprises. Finally, the characteristics of existing systems are analysed according to these requirements. The proposed requirements offer a useful framework to evaluate, compare and improve existing systems that support MIA development. Index Terms Medical image analysis distributed computing grid computing problem-solving environment@en