This special issue of Medical Image Analysis gathers 32 articles written by prominent members of the current editorial board of the journal. Each author had the opportunity to discuss a personal vision of the past and future of the field. The result is a set of outstanding visionary articles that will count as a historical landmark for our readership. It was shortly after the success of the first CVRMed conference 1 held in Nice in 1995 that we took the decision to launch a new journal entirely dedicated to the computational analysis of medical images. The founding editorial board members 2 of MedIA were among the authors of the articles of the first volume 3 of the journal published by Oxford University Press in 1996. Twenty years later, the journal (now published by Elsevier Science since 2000) has become a reference for a vibrant community of researchers working in academics, clinics and industry. It has also become the premier journal of the MICCAI Society, which organizes the Medical Image Computing and Computer Assisted Intervention conference each year on a different continent. Medical Image Analysis is now recognized as a flourishing research field at the intersection of Informatics, Computational Sciences and Medicine. Its progress contributes to the development of innovative computational tools to assist medical imaging professionals in clinical analysis and intervention.