<p>Many healthcare institutions have large archives of digital medical images. A shared dilemma is whether to purge or continue to store older radiology exams. We sought to determine if our institution’s imaging exams &gt; 10&#xa0;years old were likely to be used for clinical purposes or if they could be deleted from storage without potential lost benefit to our patients. In compliance with our institutional review board, our institutional PACS database was queried to evaluate if old exams had been opened in the last 2&#xa0;years. We analyzed by modality, body part, and subspecialty reading division. We performed a retrospective chart review of a random sampling (<i>n</i> = 100) of the identified studies to validate the assumption that many of the loaded studies were likely to have been viewed for clinical purposes. We found that over the recent past 2-year interval, our providers accessed 201,000 of 4 million (5%) imaging studies which were &gt; 10&#xa0;years of age at the time of access. We found evidence, some of it definitive, validating that many of these were viewed for clinical purposes. We conclude that if imaging studies &gt; 10&#xa0;years of age are readily available, they are commonly called upon to potentially contribute to medical decision-making. This potential value to the patient should be considered when determining whether to prune older archived imaging studies.</p>