We recently published a commentary on the impact of blood biomarkers in clinical decision-making. In this issue we shift to a similar contemporary debate surrounding over-reliance on imaging technologies to make diagnoses, often without a clinical rationale other than to rule out pathology. This strategy is not without harm to patients as illustrated by both of our experienced contributors. The place and responsibility for missed or irrelevant diagnoses following imaging will often rest on little more than inept clinical targeting, although as McCoubrie points out, the skilled radiologist may have some role in tempering everything from overzealous interpretation to simple error. Given that many techniques are based on (albeit falling) X-ray exposure and involve vastly expensive (and routinely redundant) technologies operating almost continuously, the role of skilled radiological input is more essential than ever for reducing VOMIT. Can we control inadequate imaging request strategies?