As demand for imaging continues to grow, so too do the challenges of running an efficient and viable radiology practice. Competition is fierce, utilization scrutiny is intensifying, radiologist shortages continue, turf battles are becoming more and more prevalent, and reimbursement challenges loom darker and darker. How will radiology practices survive this new era of imaging? The answer, as evidenced by other industries faced with similar challenges, is looking inward at the operation and creating the most efficient and productive workflow possible. However, most practices are so busy with day-to-day operations that they do not take the time to step back and seriously analyze their workflow. Even when new technology is introduced or equipment upgrades are implemented, workflow is not re-examined. Radiology practices need to heed the warnings of the changing times. As with other industries, a key to survival lies in the ability to optimize workflow and increase productivity. How can you leverage your equipment and staff for maximum productivity? For each major modality, we recommend the following – • Map out the entire workflow from patient scheduling to results reporting. Ensure that you include perspectives from all stakeholders in the process. Programs such as Visio contain tools to facilitate the mapping. • Identify any existing or potential failure points in the system that cause delays, bottlenecks, or multiple steps. • Research best practices, talk to colleagues, and visit other sites to gain new and objective ideas. • Simulate new processes, test scenarios and evaluate the impact. Effective tools here include simulation software or pilots. • Diagram the new process and measure the results. • Know your numbers, set aggressive targets, and manage variances on a daily basis. While the process mapping and workflow analysis takes time, it will be time well spent. The additional productivity you gain can prove to be the difference between surviving or succumbing to the changing era of imaging, an era where only the efficient are likely to survive.