The importance of imaging in the diagnosis and management of TB has varied over time. Chest radiography, in particular, has moved from its role as a key diagnostic test in all cases to one where it is now recognised as an efficient method of early TB detection. This has arisen in part due to the introduction of new digital radiographic approaches (both in performance and reading) as well as changes in global TB policies to detect all TB cases irrespective of their infectiousness. Combined with clinical and microbiological data, radiography remains helpful in both TB diagnosis and follow-up in a large number of patients. However, in some cases imaging tools with a higher specificity are required, e.g. computed tomography or magnetic resonance imaging. These may be particularly useful in EPTB, paucibacillary and immunocompromised patients. The relatively high cost of modern imaging diagnostics remains a barrier to their wider adoption in high-burden TB settings.