Prognostication in the configuration of the structure and economics of medicine is a risky business. Unlike scientific experiments, we do not and cannot know all the variables pertinent to the delivery of healthcare, because the likelihood that any innovation will enter practice is subject to many uncertainties. First to consider or confound is the trajectory of its further development, of course. Yet also one must pay attention to the impress of competing technology as well as legal, political, financial, sociocultural and now transnational influences, each of which may become compelling and even determinative almost overnight. For example, take note of how quickly the current fiscal crisis has transformed values, settled elections and stimulated legislation that might have revolutionary consequences about how, why and by what means care is rendered.

Nonetheless, the record of the past 40 years in Radiology could serve as precedent for what unexpected initiatives we should, paradoxically, come to expect, deal with and potentially considerably benefit from. In the 1970s and 1980s Radiology was transformed by the introduction of imaging techniques which fundamentally improved on conventional radiography, through CT predominantly, as well as the harnessing of other energy sources to create incisive pictures like ultrasonography with sound waves, various gamma ray generating imaging protocols in nuclear medicine, and the perturbation by radio waves of magnetic fields to form the basis of MRI. In the 90s there were further developments in nuclear medicine, MRI, and ultrasound. Moreover, CT, particularly, advanced with implications for patient care and its costs. And interventional procedures with imaging added another dimension to the ascendancy of Radiology. It was also the time of the beginning of the information technology revolution, allowing images to be as easily handled as words, and all information to be free of the fetters of space and place.

The result of these multi-phasic quantum leaps of improvements afforded by the digitization of images and the deployment of web-based communication enabled the birth and then the explosive growth of teleradiology, which has gone from tentative beginnings less than a decade ago to near widespread deployment, becoming along the way a multibillion dollar enterprise.