Computerized voice recognition systems (VR) can reduce costs and enhance service. The capital outlay required for conversion to a VR system is significant; therefore, it is incumbent on radiology departments to provide cost and service justifications to administrators. Massachusetts General Hospital (MGH) in Boston implemented VR over a two-year period and achieved annual savings of $530,000 and a 50% decrease in report throughput. Those accomplishments required solid planning and implementation strategies, training and sustainment programs. This article walks through the process, step by step, in the hope of providing a tool set for future implementations. Because VR has dramatic implications for workflow, a solid operational plan is needed when assessing vendors and planning for implementation. The goals for implementation should be to minimize operational disruptions and capitalize on efficiencies of the technology. Senior leadership--the department chair or vice-chair--must select the goals to be accomplished and oversee, manage and direct the VR initiative. The importance of this point cannot be overstated, since implementation will require behavior changes from radiologists and others who may not perceive any personal benefits. Training is the pivotal factor affecting the success of voice recognition, and practice is the only way for radiologists to enhance their skills. Through practice, radiologists will discover shortcuts, and their speed and comfort will improve. Measurement and data analysis are critical to changing and improving the voice recognition application and are vital to decision-making. Some of the issues about which valuable date can be collected are technical and educational problems, VR penetration, report turnaround time and annual cost savings. Sustained effort is indispensable to the maintenance of voice recognition. Finally, all efforts made and gains achieved may prove to be futile without ongoing sustainment of the system through retraining, education and technical support.