Advances in radiology over the past 20 years are the product of a technologic imperative that has produced new approaches to the acquisition of medical images and modifications to conventional approaches. The imperative has placed radiology at the leading edge of the computer-technology era of modern medicine and has also produced several big-ticket technologies that have been identified as major contributors to rising health care costs. Consequently, the demands for quantitative data on the impact and cost-effectiveness of the use of these technologies in the clinical arena are increasing. Meeting the growing demand for accountability in radiology requires that the discipline adopt innovative approaches for assessing its technologies and acquire new types of data, including documentation of cost savings accrued by selective use of radiologic technologies and demonstration of the efficiency and cost-effectiveness of triage schemes that lead to more effective decision making. The requirement of quantitative accountability represents a new way of doing business for radiology and a new approach to management for those responsible for business.