In Johns Hopkins therapeutic radiology, we perform 2,600 procedures in neurointervention and 14,000 peripheral interventions each year, totalling over 16,000 image-guided procedures a year in 14 rooms. We changed our approach to image guided therapy in June 2001, when we installed a new O.5 mm multidector CT (Aquilion, Toshiba America Medical Systems) and two 3D visualization workstations (Vital Images, USA, and Zio Imaging, Japan) in our Interventional Neuroradiology Department. A new world of radiology was opened for practice, development and research. The improved resolution offers superb detail. We perform diagnostic imaging, prepare for interventional procedures, and do non-invasive post-procedural follow-ups in this room that is like an angiographic suite. The in-room monitor and console enable procedure performance and image guidance monitoring. I sincerely believe this technology will compete directly with conventional angiography over the next five years. I am able to perform more complex cases than ever in a manner that is better for patients, both in terms of comfort and safety.