Discussions of medical imaging technologies often leave the connection between imaging, visualization, and vision ambiguous, which fails to explain the visual and technological nature of the images. I argue that this is because the standard way that account of image interpretation are constructed gets the explanatory order wrong; rather than looking to image use to explain interpretation, image use should be explained by image interpretation. An account of imaging that takes visual interpretation as primary has more explanatory power and provides new tools for analysis and critique of medical imaging.