The Image Perception & Performance Conference has not been a track in the SPIE Medical Imaging Meeting for 40 years, but has been an integral part of the meeting since its inception in 1994 in a variety of ways. Everything discussed at the SPIE Medical Imaging meeting, whether overtly discussed or implied, relates back to one fundamental idea - developing better tools for radiologists and other clinicians to render more effective and efficient diagnostic decisions. Thus image perception and observer performance issues are fundamental to the medical imaging field. This poster highlights some of the trends observed since 1994 years at the SPIE Medical Imaging meeting as they relate specifically to the Image Perception & Performance Conference. The Image Perception track has covered a wide variety of areas, including Methods for Assessing Performance, Mathematical Observer Modeling, Human-Computer Interface & Ergonomics, Eye-Tracking & Visual Search, and Clinical Decision Making. Investigation of the perceptual and cognitive factors underlying medical image interpretation is an important and valuable endeavor that contributes significantly to our continuing efforts to improve the detection, diagnosis and treatment of diseases to improve patient care and wellbeing. Collaborations between medical physicists, workstation design engineers, image processing and image analysis scientists, and vision and cognitive psychologists should be encouraged to facilitate and promote further research in medical image perception so that patient care can be improved.