The business of healthcare continues to change and radiology groups are looking beyond the bare branches of low hanging fruit which have provided short-term fixes to various business and reimbursement challenges. Radiologists now need to climb high in the trees to identify the large and small drivers of long-term financial sustainability. RSNA 14 was definitely a valuable venue for getting that information and getting up to speed on the latest innovations in radiology, practice management tools and progress on coordinated efforts like interoperability.