For 35 years, the Nationwide Evaluation of X-Ray Trends (NEXT) survey program has characterized trends in the state of practice in diagnostic radiology. Since 1972, NEXT, a joint effort of the US Food and Drug Administration (FDA) and the Conference of Radiation Control Program Directors (CRCPD), with support from the ACR, has captured data related to patient exposure, diagnostic image quality, examination workloads, and quality control and assurance practices for selected examinations, including adult and pediatric chest, abdominal, lumbosacral spinal, and dental radiography; upper gastrointestinal fluoroscopy; mammography; and computed tomography (CT). A brief summary of the programs history and highlights of current activities and future plans are provided here.