Tensor based orientation adaptive filtering, an explicit methodology for anisotropic filtering, constitutes a flexible framework for medical image enhancement. The technique features post-filtering steerability and allows user interaction and direct control over the highfrequency contents of the signal. A new class of filters for local structure analysis together with filter networks significantly lowers the complexity to meet the requirements of computation time for clinical use, while maintaining accuracy. In this paper the technique is applied to low-dose CT-images, magnetic resonance angiography and T2-weighted MRI.