Many regulatory and oversight groups require that the professional performance of radiologists be evaluated on an ongoing basis. Although the diagnostic accuracy of radiologists is routinely measured at most institutions by means of peer review processes, systems for evaluating procedural competency are not widely available. Consequently, technical skills are seldom, if ever, evaluated or managed. The key elements of a system for evaluating procedural competency include the following: (a) clear definition of all elements of a transparent evaluation process; (b) definition of standards for training and credentialing and options for maintenance of competency certification in interventional procedures; (c) collection and analysis of process and outcomes metrics; (d) multisource feedback on procedural, patient care, and safety skills; and (e) an effective, anonymous process for managing radiologists in whom deficiencies are identified. Although no ideal system for evaluating procedural competency currently exists, inclusion of these elements goes a long way toward facilitating the introduction of a simple process for providing appropriate feedback to procedural radiologists, acknowledging excellence, and identifying and managing deficiencies if they occur.