Radiological image and data archives contain huge amounts of data which are barely utilized by current technologies. In the future semantic technologies currently under development will enable analysis of the contents not only on the level of individual patients but also along entire data collections thereby resulting in new applications that will benefit routine clinical practice, teaching activities and research. As a prerequisite the development of software for semantic analysis of image and report contents is necessary, i.e. an "understanding" of the contents by the software. Based on specific ontologies, standardized protocols and semantic image annotation new systems will be developed that make the content of these data archives accessible and support diagnosis, quality assurance, innovative research applications and last not least, the merging of data of different medical disciplines, such as radiology, pathology and clinical chemistry.