Despite spectacular scientific advance and contributions to patient care, radiology stands at a frightening crossroads in its 100-year history. Economic and political changes endanger the fundamental principles of patient care, research, and teaching and threaten to dismantle the subspecialized expertise that characterizes our great academic medical institutions. In response, we should be creative and find new ways to exploit this expertise in an effort to maintain clinical and research excellence. Teleradiology can be used to improve the quality and decrease the cost of medical care at home and abroad--meeting the challenge of the 1990's. Teleradiology and other telemedical applications can benefit from the nation's investment in telecommunications infrastructure. The enabling technologies to provide teleradiology services are available and the feasibility of performing primary interpretations has been established. We offer our experience and plans as a model for diversifying and strengthening the academic radiology department of the future.