Lumbar imaging is frequently requested in patients with low back pain for various reasons. However, the prevalence of severe lesions, including neoplastic, is only about 1%. Imaging in the absence of clinical suspicion performs poorly. Similarly, the imagery is no more likely to identify the anatomical structures that are the source of pain for patients with low back pain. Finally, the literature shows that the impact on treatment decisions and the effect on quality of life of patients cannot justify an indiscriminate use of these investigative techniques. Without questioning the value of imaging, the practitioner must keep in mind these limitations in order to optimize the use of this resource.