The Covid-19 pandemic surges of 2020 resulted in major operational, personal, and financial impacts on US radiology practices. In response, a series of strategic and intentional operational changes were implemented, varying by practice size, structure and model. In reviewing the many business lessons that we learned during the pandemic, it became clear that for a business to be successful, a host of additional supportive factors are necessary. In addition to timely expense reductions, optimizing revenue capture and close monitoring and management of cash and reserves available for use, we also consider effective leadership and communication strategies, maintenance of a healthy and adequately staffed team, support for a remote work environment and flexible staffing models. Other ingredients include effectively embracing digital media for communications, careful attention to current and new stakeholders and the service delivered to them, understanding federal and state regulatory changes issued in response to the pandemic, close collaboration with the Human Resources office, and an early focus on redesigning your future practice structure and function, including disaster and downtime planning. This review aims to share lessons to enable leaders of an imaging enterprise to be better prepared for similar and future surges.