This paper describes a virtual image chain for medical display (project VICTOR: granted in the 5th framework program by European commission). The chain starts from raw data of an image digitizer (CR, DR) or synthetic patterns and covers image enhancement (MUSICA by Agfa) and both display possibilities, hardcopy (film on viewing box) and softcopy (monitor). Key feature of the chain is a complete image wise approach. A first prototype is implemented in an object-oriented software platform. The display chain consists of several modules. Raw images are either taken from scanners (CR-DR) or from a pattern generator, in which characteristics of DR- CR systems are introduced by their MTF and their dose-dependent Poisson noise. The image undergoes image enhancement and comes to display. For soft display, color and monochrome monitors are used in the simulation. The image is down-sampled. The non-linear response of a color monitor is taken into account by the GOG or S-curve model, whereas the Standard Gray-Scale-Display-Function (DICOM) is used for monochrome display. The MTF of the monitor is applied on the image in intensity levels. For hardcopy display, the combination of film, printer, lightbox and viewing condition is modeled. The image is up-sampled and the DICOM-GSDF or a Kanamori Look-Up-Table is applied. An anisotropic model for the MTF of the printer is applied on the image in intensity levels. The density-dependent color (XYZ) of the hardcopy film is introduced by Look-Up-tables. Finally a Human Visual System Model is applied to the intensity images (XYZ in terms of cd/m2) in order to eliminate nonvisible differences. Comparison leads to visible differences, which are quantified by higher order image quality metrics. A specific image viewer is used for the visualization of the intensity image and the visual difference maps.