The field of radiology has expanded dramatically and now encompasses a broad range of imaging examinations and image guided procedures. These imaging technologies are powerful tools which provide valuable information, and combining modalities further enhances their value. The changes our imaging technologies have brought bring into question our training methods, especially the value of the clinical year prior to entering radiology. As the quality of our health care systems is being challenged, demonstration of both quality processes and outcomes are needed. Maintenance of Certification, which demonstrates continuing learning and practice improvement, has become an important part of a radiologist’s quality credentials.