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Healthcare underpins the wellbeing of mankind. It is manifested by our ability to diagnose disease and to treat patients effectively. Naturally, the better we understand a disease, the more accurate we can be in its diagnosis and the more effectively we can be in treating it. Over the centuries, our skills in these domains have continually improved. Today, our diagnostic armamentarium includes multiple, noninvasive imaging methods, including computed tomography (CT), magnetic resonance imaging (MRI) [2], single photon emission computed tomography (SPECT) and positron emission tomography (PET) [3]. Although we tend to dichotomize these into anatomical and molecular or functional imaging modalities, there is often physiological and chemical information that can be derived from the former and anatomical structure can be recognized in the latter. Al l of these imaging modal i t ies are exci t ing instrumentational and methodological approaches to diagnosing and characterizing diseases [4]. Anatomical and functional imaging coexisted for decades until, in the 1990s, the use of combined Banato-metabolic^ imaging [5] was proposed and subsequently resulted in the introduction of combined SPECT/CT [6], PET/CT [7] and then PET/MR systems [8] in the first decade of the twenty-first century. Although the adoption of these hybrid imaging systems has varied widely over time and across regions, their clinical traction has grown with resulting diagnostic benefit across a variety of clinical applications [9–11]. The ultimate goal of technological progress in diagnostic medicine should be to maximize diagnostic quality and, thus, positively influence patient management and benefit wellbeing. Yet it is noticeable from evidence in the literature and our own insights into the clinical practice of our expert colleagues that hybrid imaging is often not used to its full potential due to failure to integrate complementary medical expertise for the maximum benefit of patients. While there is much focus on reducing radiation exposure according to principles known by the acronym ALARA (as low as reasonably achievable), we believe that similar attention should be given to the clinical performance of imaging tests, which could be termed AHADA (as high as diagnostically achievable). At the time of stand-alone anatomical and molecular medicine imaging, radiology and nuclear medicine progressively moved apart and came to be represented by different professional societies in most countries. When hybrid imaging was introduced in the form of SPECT/CT, PET/CT and – perhaps most vividly – PET/MR, both groups were taken by surprise. While hybrid imaging originated from pioneering work in the nuclear medicine community with cross-disciplinary teams of physicists, engineers and medical doctors [12], perceptions of how hybrid imaging technologies might be used were subject to an ownership bias [13]. Such bias was born and voiced with the introduction of the whole-body PET/CTconcept in the late 1990s, as illustrated by comments such as: BI think fusion is overblown in reputation. Good nuclear medicine physicians can correlate just as well using internal landmarks^, and BMany nuclear medicine physicians interpret CT images more accurately than trained radiologists^ [14]. Later, during the clinical adoption of hybrid imaging, comments such as these were made: BPET/CT is the death of nuclear medicine^ (personal communication; anonymous delegate at the Annual Meeting of the German Nuclear Medicine Society, 2000), or BWe estimate that there is a need to look at CT scans in * T. Beyer thomas.beyer@meduniwien.ac.at

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