The advent of advanced imaging modalities in the past 20 years represents a paradigm shift as physicians seek new ways to offer earlier diagnosis and treatment and to augment practice service and revenues. A physician-owned, office-based imaging project has evolved from conventional X ray to more advanced imaging, which includes MRI, CT, and other digital imaging methods. Orthopedic practices need to do a thorough analysis to match the technology and type of unit to the patient volume and prospective payment for the services rendered. This analysis should include understanding the capability and limitations of the MRI or other imaging modality selected, staffing, siting, and teleradiology interpretations. This article elucidates this general trend in orthopedic imaging and examines practical aspects of the physician/practice-owned imaging center.