A system and method for managing medical image data items. Pixel data and metadata are identified in the medical image data items. A plurality of pixel objects are generated using the pixel data. The plurality of pixel objects are stored in a first storage memory. A plurality of representative objects are generated using the metadata. The representative objects are stored in a second storage memory. The representative objects may include overview objects and representative metadata objects. The representative objects can be generated in a DICOM-compatible format suitable for PACS workflows.