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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jacr.2008.11.004 Byline: Bruce I. Reiner, Eliot L. Siegel Keywords: Quality assurance; commoditization; pay for performance Abstract: The current focus on the economic bottom line in health care creates the potential for radiology to become a commodity, devoid of qualitative differentiation. This trend toward commoditization has been accelerated by the globalization of imaging services (teleradiology), increased information exchange (eg, Digital Imaging and Communications in Medicine, Integrating the Healthcare Enterprise), and new technology development (eg, picture archiving and communication systems, computer-aided diagnosis). The optimum strategy for avoiding commoditization is the creation of objective quality metrics and standards throughout the medical imaging practice, which will provide a reproducible and objective means with which to differentiate imaging service deliverables on the basis of quality and clinical outcomes. These quality measures can in turn be directly tied to economic incentives (pay for performance), providing further incentive for proactive quality assurance, qualitative differentiation, and technology development centered on quality. Author Affiliation: Department of Diagnostic Imaging, Baltimore VA Medical Center, Baltimore, Maryland