In this paper, we propose a novel scheme for efficient content-based medical image retrieval, formalized according to the PAtterns for Next generation DAtabase systems (PANDA) framework for pattern representation and management. The proposed scheme involves block-based low-level feature extraction from images followed by the clustering of the feature space to form higher-level, semantically meaningful patterns. The clustering of the feature space is realized by an expectation-maximization algorithm that uses an iterative approach to automatically determine the number of clusters. Then, the 2-component property of PANDA is exploited: the similarity between two clusters is estimated as a function of the similarity of both their structures and the measure components. Experiments were performed on a large set of reference radiographic images, using different kinds of features to encode the low-level image content. Through this experimentation, it is shown that the proposed scheme can be efficiently and effectively applied for medical image retrieval from large databases, providing unsupervised semantic interpretation of the results, which can be further extended by knowledge representation methodologies.