This is a report of CARS 2006 (Computer Assisted Radiology and Surgery 20th International Congress and Exhibition) held at Osaka, Japan during the period of June 28-July 1, 2006. This congress has been held every year for 19 years since 1985, with the aim to provide a forum to close the gap between diagnostic and interventional radiology, surgery and informatics. This report describes my first experience of the presentation at an international congress.