Modern radiology departments need radiologists who understand subjects not thoroughly addressed during residency training: picture archiving and communication system (PACS) technology and administration, usability and acceptance testing, workflow analysis, digital image acquisition, compression, and quality control. A structured Electronic Imaging and Technology (EIT) fellowship program focusing on practical, technical, and administrative aspects of electronic imaging, teleradiology, and PACS was formed at the Mayo Clinic, Rochester, Minnesota. We review the rationale for dedicated EIT training, define its core curriculum, and discuss the purpose of an EIT specialist. Resources necessary to optimize this fellowship are discussed. Scheduling and coordination with clinical training is presented. The responsibilities and deliverables expected of an EIT fellow are examined. We differentiate the EIT fellowship from an Informatics fellowship and explore the role an EIT specialist within a department. An EIT fellowship provides practical and valuable skills, and can be compared to the added expertise gained through established fellowship training programs.