In this article, we will discuss the challenges and opportunities for imaging journals in the next decades. These include: the importance of optimizing online communication to enhance exchange of ideas in the sciences and the necessity to facilitate the development of quantitative tools that will aid in risk stratification, diagnosis, monitoring of therapy, and disease surveillance in an era of "P4 medicine". Journals will also need to promote the evidence-based evaluation of promising technologies so that the resources expended in healthcare may be most effectively used.