There has been a steady increase in emergency department (ED) visits worldwide over the past decade. Correspondingly, the utilization of the imaging in the ED is on the rise. The ED clinician today has a multitude of imaging modalities at his or her disposal, depending on the appropriateness of the modality for the presentation, and on availability. Radiography and ultrasound are the most widely available modalities and often are part of the initial assessment of the patient. Point-of-care ultrasound has gained increasing attention and become more prevalent in the ED (and is used by both ED personnel and radiology) as a screening tool. Computed tomography (CT) has become the workhorse of advanced imaging in the ED given its growing availability, excellent anatomical resolution, and speed. Substantial advances have been made in CT technology, allowing for even faster image acquisition, reduction in dose, and analysis of tissue characteristics. Magnetic resonance imaging (MRI) and nuclear medicine have a more limited role in the initial assessment in the ED, are less readily available after hours, and often serve as a second- or third-line modalities for problem-solving purposes, although for selective indications MRI is increasingly being used emergently in some regions and practices, if available. Choosing the correct modality with the highest yield and avoiding potential harm to the patient as well as limiting costs to the system is a joint effort between the ED clinician and the radiologist.