Change is a constant in radiology. Yet the visibility of that change depends upon the thing altered. The introduction of a new modality or an advanced technique is readily manifest as it is demonstrated in the production of novel images. Modifications of reimbursement or the announcement of new regulations are usually publicized before their imposition so that while they may be startling, they are not unexpected, at least in the immediate term. In contradistinction, there are profound changes that do not broadcast their arrival as they are the result of gradual alterations of attitude or slowly developing realignments of opportunities or even sometimes the subliminal redirection of perspectives held by regulators policy planners, or competitors. Such new realities are generally perceptible in both their evolution and inevitability by those attuned to look for trends. Yet for most radiologists, they are apt to burst on the scene assertively, belatedly and unheralded.