Ramandeep Singh, MD, Associate Chief Health Information Officer and Director of Imaging Informatics at University of Iowa Health Care, breaks down the radiologist shortage equilibrium and the workforce, volume, and reimbursement trends driving it. He details a four-pillar governance model, the scalability case for cloud PACS, an on-prem backup strategy for business continuity, and how his team went live on PACS and dictation in five to six months.