For the first 125 years of medical imaging, technological advances focused primarily on new modes of imaging as technology progressed from the discovery of the X-ray in 1895 to ultrasounds, MRIs, PET and CT scans in the late 20th century. Now, arguably, the most notable advances are being made in how images from those technologies are securely shared, managed, stored and assessed. These advancements are largely due to the application of artificial intelligence (AI) and machine learning (ML) to imaging systems and data platforms. Automation is improving virtually every stage of the imaging workflow, but there is a lot of hype concerning AI and ML in the marketplace. Companies have underestimated the challenge that complexity presents, and predictions of the end of radiologists have proven false multiple times.