OBJECTIVES: In recent years, there have been many important advances in medical devices designed to provide diagnostic and surgical imaging and visualization. This presents an important health economics and outcomes research challenge: how can we quantify the economic value of incremental improvements in imaging and visualization? This project was focused on developing a conceptual economic framework to describe the basic structure of economic evaluations of visualization. METHODS: The project had three parts. First, we conducted interviews with two groups of key opinion leaders: (1) medical devices product leaders in industry, and (2) physicians who use the devices. Industry experts were asked about design attributes and the engineering intent of improvements in visualization, and physicians were asked about clinical utility. Second, we conducted a comprehensive review of the literature on the economics of diagnostics and the clinical utility associated with visualization. Third, we used the interviews and the literature to construct a conceptual framework for economic evaluation. RESULTS: The primary goals of the conceptual framework were to: (1) develop an understanding of the clinical utility associated with visualization devices, and to identify measures that quantify clinical utility; (2) identify economic outcome measures associated with clinical utility; and (3) develop a template framework to which most “economics of visualization” problems could be applied. The conceptual model takes into account some general issues pertaining to economic evaluation of diagnostics, critical elements for health technology assessment agencies, and practical issues concerning measurement of outcomes. The conceptual model consists of a decision tree framework and a narrative description of the variables, pathways, and logic. CONCLUSION: As engineering and scientific advances in visualization accelerate, it is necessary to develop technology assessment tools that weigh the costs and benefits of improvements in visualization and the relationship with diagnostic accuracy and surgical visualization.