A system and method allows for the annotation of an image stream, which may be produced by, for example, an ingestible capsule. A workstation accepts images acquired by the capsule and displays the images on a monitor as a moving image. A user inputs an annotation which corresponds to a portion of the moving image, and the annotation is recorded in a database associated with the selected portion. The annotation may include, for example, textual notes regarding the image portion. The annotations may be displayed at a later time.