Quality of Service support is an important prerequisite for the adoption of Grid technologies for medical applications. The GEMSS Grid infrastructure addressed this issue by offering end-to-end QoS in the form of explicit timeliness guarantees for compute-intensive medical simulation services. Within GEMSS, parallel applications installed on clusters or other HPC hardware may be exposed as QoS-aware Grid services for which clients may dynamically negotiate QoS constraints with respect to response time and price using Service Level Agreements. The GEMSS infrastructure and middleware is based on standard Web services technology and relies on a reservation based approach to QoS coupled with application specific performance models. In this paper we present an overview of the GEMSS infrastructure, describe the available QoS and security mechanisms, and demonstrate the effectiveness of our methods with a Grid-enabled medical imaging service.