In a previous essay we considered the matter of increasing utilization of diagnostic imaging from the point-of-view of threats to radiology hegemony by physicians in other specialties. Much concern has been raised about self-referral by non-radiologists and its effect on healthcare costs, radiation exposure for those tests using ionizing radiation and overall a balkanization of radiology into many self-contained and hence poorly regulated pockets of imaging initiatives. This is, of course, a very big problem but before proceeding to remedies one must recognize that it is not the whole issue. In a debate several years ago held at a Spring meeting of the American College or Radiology, one did not hear anything about radiologist self-referral. The absence of discussion about this phenomenon does not mean that our adversaries will not discuss it when the debate starts to rage. They will for sure consider that point, at least to counter the proposals organized Radiology offers, which will have the effect of regulating or removing competition. That story needs to be recited and debated if we are to retain credibility in the matter at hand i.e. how do we limit or stop the unfettered self promotion of imaging by non-radiologists?