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The results of a survey sent to practice leaders in the ACR Practice of Radiology Environment Database show that the majority of responding groups will continue to hire recently trained residents and fellows even though they have been unable to take the final ABR diagnostic radiology certifying examination. However, a significant minority of private practice groups will not hire these individuals. The majority of private practices expect the timing change for the ABR certifying examinations to affect their groups' function. In contrast, the majority of academic medical school practices expect little or no impact. Residents and fellows should not expect work time off or protected time to study for the certifying examination or for their maintenance of certification examinations in the future.

The universe of medical practice is changing at an ever increasing rate, an exponentially increasing rate. In examining Earth's history from the beginning of time, it is not necessarily change per se that has threatened countless species but the rate of change that has challenged species survival. Darwin's thesis indicates that those who are most able to adapt to change will be more likely to survive. Medical technology, especially imaging technology, has been on a exponential growth curve for the past 2 decades, dramatically changing not only the field of medical imaging but the environment of all of medicine. Change in our practice environment represents both threats and opportunities to medical specialties to adapt and survive in the context of radiology and remain relevant to the future practice of medicine. Can we as radiologists survive and remain relevant in the future practice of medicine? What is the path to survival? The approach to survival will be multifactorial. We must continue to put our patients first, maintaining high-quality patient care in our adaptation strategy. We must do a better job of developing and investing in leaders, not only within radiology, but within all of medicine. We will need to hypersubspecialize within our profession and with that hypersubspecialization develop an integrated team concept, working together like a well-oiled Swiss watch. Last, we must as a profession invest in ourselves vigorously, supporting imaging research in a number of arenas, searching for the next imaging breakthrough, and exploring and adapting nanotechnology applications in both imaging and therapy.

Telemedicine is becoming an increasingly important tool in the practice of medicine throughout the world. For radiologists, telemedicine translates to teleradiology. Because an increasing amount of imaging is now archived in a digital format, and with the application of more powerful computers in radiology, digital image transmission between display stations is becoming commonplace. The ability to move large diagnostic image data sets to display stations anywhere in the world using the Internet and other high-speed data links is solving some problems and creating others. Medicine and radiology will be challenged in many ways by the issues created from the application of this burgeoning technology. Our task force was charged with investigating the evolving practice of international teleradiology and with developing a pubic statement to be adopted by the ACR Council (http://www.acr.org). This white paper is our effort to define those issues we believe to be most pertinent to international teleradiology as we know them today. Will these issues be changing? Certainly. For some facets of the issue, there are currently more questions than answers. We describe several scenarios that we believe are acceptable practices of international teleradiology as well as some that are not. We believe that much will be written about international teleradiology in the future as the issues of credentialing, quality assurance, licensure, American Board of Radiology certification, the maintenance of certification, jurisdictional and medical liability issues, patient privacy, fraud and medical ethics are more precisely defined and shaped by state and federal legislation and medical jurisprudence. This white paper is our assessment of what we believe to be the major challenges that exist as of this writing.