Abstract: Medical imaging feeds research in many computer vision and image processing fields: image filtering, segmentation, shape recovery, registration, retrieval and pattern matching. Because of their low contrast changes and large variety of artifacts and noise, medical imaging processing techniques relying on an analysis of the geometry of image level sets rather than on intensity values result in more robust treatment. From the starting point of treatment of intravascular images, this PhD thesis ad- dresses the design of differential image operators based on geometric principles for a robust shape modelling and restoration. Among all fields applying shape recovery, we approach filtering and segmentation of image objects. For a successful use in real images, the segmentation process should go through three stages: noise removing, shape modelling and shape recovery. This PhD addresses all three topics, but for the sake of algorithms as automated as possible, techniques for image processing will be designed to satisfy three main principles: a) convergence of the iterative schemes to non-trivial states avoiding image degeneration to a constant image and representing smooth models of the originals; b) smooth asymptotic behav- ior ensuring stabilization of the iterative process; c) fixed parameter values ensuring equal (domain free) performance of the algorithms whatever initial images/shapes. Our geometric approach to the generic equations that model the different processes approached enables defining techniques satisfying all the former requirements. First, we introduce a new curvature-based geometric flow for image filtering achieving a good compromise between noise removing and resemblance to original images. Sec- ond, we describe a new family of diffusion operators that restrict their scope to image level curves and serve to restore smooth closed models from unconnected sets of points. Finally, we design a regularization of snake (distance) maps that ensures its smooth convergence towards any closed shape. Experiments show that performance of the techniques proposed overpasses that of state-of-the-art algorithms.