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There is a significant increase in the use of medical images in clinical medicine, disease research, and education. While the literature lists  several  successful  systems  for  content-based  image retrieval  and  image  management  methods,  they  have  been unable  to  make ,significant  inroads  in  routine  medical  informatics. This  can  be  attributed  to  the  following:  (i)  the  challenging nature of medical images, (ii) need for specialized methods specific  to  each  image  type  and  detail,  (iii)  lack  of  advances in  image  indexing  methods,  and  (iv)  lack  of  a  uniform data  and  resource  exchange  framework  between  complementary systems.  Most  systems  tend  to  focus  on  varying  degrees of the first two items, making them very versatile in a small sampling of the variety of medical images but unable to share their strengths. This paper proposes to overcome these shortcomings by  defining  a  data ,and  resource  exchange  framework using open standardsand software to develop geographically distributed  toolkits.  As  proof-of-concept,  we  describe the  coupling  of  two ,complementary  geographically  separated systems:  the  IRMA  system at Aachen University of Technology in  Germany,  and  the  SPIRS  system  at  the  U.  S.  National Library of Medicine in the United States of America. Keywords: Medical informatics applications, image informa-

Geographically Distributed Complementary Content-Based Image Retrieval Systems for Biomedical Image Informatics.