The paradox of the increased use of imaging without obvious evidence of improved health outcomes has led to calls for payment based on value rather than volume. Measurement of radiologists’ performance is a key component of the measurement of value. The paradigm shift occurring in radiology and health care as a whole may seem daunting to the radiologist with the clamor for increasing accountability from payers and patients alike. However, it is through powerful tools such as performance measures in radiology and their accompanying incentive-based payment systems that practices can be improved and confidence of patients restored.