Overuse of health care in the United States is a growing concern. This article addresses the use of diagnostic imaging for work-related injuries. Diagnostic imaging drives substantial cost for increases in workers’ compensation. Despite guidelines published by the American College of Radiology and the American College of Occupational Medicine and the Official Disability Guidelines, practitioners are prematurely ordering imaging sooner than recommended. Workers are exposed to unnecessary radiation and are incurring increasing costs without evidence of better outcomes. Practitioners caring for workers and submitting workers’ compensation claims should adhere to official guidelines, using their professional judgment to consider financial impact and health outcomes of diagnostic imaging including computed tomography, magnetic resonance imaging, nuclear medicine imaging, radiography, and ultrasound.