Imaging studies are finding increasing applications in clinical medicine. Fueling this have been advances in technology that have expanded the range of applications and have improved their clinical performance, (i.e., diagnostic sensitivity and specificity). In addition, in many cases the risks associated with imaging procedures are minimal. The combined effect has been a tilt in the cost-benefit balance in favor of expanded use. Recent economic pressures, however, are adding increasing weight to cost considerations, requiring many to rethink their approach to the development of improved or fundamentally new imaging technologies. In this report, we examine some fundamental and practical issues that can be expected to influence future development of imaging technologies. We also discuss approaches that we are taking to develop NIR imaging methods, which we believe have significant potential for improving the performance for certain applications while maintaining high cost-effectiveness.