The growth of radionuclide imaging has raised well-founded concerns about potential overutilization. In response to the need for guidance, appropriate use criteria have been developed, which categorize specific clinical scenarios such as whether radionuclide imaging would be reasonable (appropriate) to perform, or whether the test would be performed for uncertain or inappropriate indications. Using these criteria, practice patterns may be evaluated and information provided to practitioners regarding test ordering. This information, along with clinical decision support, may provide a foundation to improve the utilization of cardiac imaging, preserving patient access to these procedures, but with an emphasis on cost-effectiveness and safety.