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Medical device development is increasingly under market pressure to reduce deployment in critical care facilities. Further, budget cuts in critical care facilities drive process innovation mostly realized through a holistic integration of IT systems (hospital information systems, PACS and modalities). One important leverage to reduce development cycle time is to introduce learn/ agile requirements engineering approaches. Traditional V-model based development processes cannot cope with the pressure from the market. Given that the content of software in medical device has risen bigger than 60% (compared to 30% by end of the ‘90s), lean/agile RE is becoming a paramount discipline for a development organization to remain competitive. Our own experience and an underlying business case show concrete cost savings in the project planning, testing and complexity reduction of the imaging platform architecture. A comparison of traditional to learn/ agile requirements engineering rounds up the picture including key takeaways.