The design of the modern medical imaging department must meet several seemingly divergent needs. It must accommodate highly technical medical equipment that is generally large, heavy, and noisy—with extensive infrastructure and shielding requirements. It must also create a safe, pleasant, and efficient work environment for staff. Last but not least, it must comfort patients who are likely anxious or scared. Several new developments in medicine and architecture are influencing the design of medical imaging facilities. Recent trends and science impact building planning, design, and construction in any radiology setting. An understanding of what has changed—and what has not—is essential to developing safe, productive, and comfortable imaging departments and outpatient imaging centers.