When Barry D. Pressman, MD, FACR, began his radiology career, Nixon was resigning from the White House and neuroradiology was just developing as a specialty. Musculoskeletal radiology largely meant reading bone radiographs. Pressman says, “CT came on the scene in 1972, but we didn’t even know how to spell it yet. Now, we have all these new modalities that are sophisticated and that apply to different parts of the body.” As chair of the S. Mark Taper Foundation Imaging Center and Department at Cedars-Sinai Medical Center (Los Angeles, California), Pressman maintains a highly subspecialized department. He believes strongly that radiologists must continue to evolve if they are to deal with an increasingly competitive environment adequately. When he took the reigns as president of ACR® in 2008, he made his position clear in language that pleased some and dismayed others. In the words of his presidential address,1 “Nonradiologists are more and more interested in vertically integrating imaging into their practices, while teleradiology and PACS are resulting in greater isolation of radiologists. Commoditization is a realistic and devastating threat to the survival and professionalism of the specialty. To remain viable as a specialty, radiologists must elevate their practice by subspecializing, becoming more involved with clinical care, and actively interacting with patients and referring clinicians. Distinction will prevent extinction.”