<h3>Rationale and Objectives</h3> To review US health care trends related to medical imaging utilization and costs as well as to present standard methods for conducting economic evaluation for health care interventions and medical imaging specifically. <h3>Materials and Methods</h3> A review of the medical literature was performed to assess health policy and health technology assessment trends, expenditures, and cost-effectiveness analysis (CEA) related to medical imaging. Standard approaches to conducting economic evaluation and cost-effectiveness analysis were reviewed and summarized. Examples of CEA evidence related to imaging in select oncology conditions were presented. <h3>Results</h3> Several high-quality methodology publications have provided guidance for conducting economic evaluation and CEA in radiology. There is variability in the quality of CEA models and their dissemination. However, there are numerous methodologically sound cost-effectiveness analyses for radiology procedures, and the evidence base of CEA studies for medical imaging continues to increase. Advanced imaging approaches for diagnosing and staging oncology conditions have the potential to provide cost-effective care when used in appropriate patient subpopulations. <h3>Conclusions</h3> Additional rigorous comparative effectiveness studies for advanced imaging, including cost-effectiveness analyses, can provide useful information to policy makers and health care providers on the relative effects and costs associated with diagnostic alternatives.