Exactly 21 years have passed since John Besson’s chapter ‘Imaging’ in the previous edition of these seminars. There has been an amazing proliferation of imaging methods, but very little change in the clinical imaging protocols available to the average UK clinician. X-ray computed tomography still seems to be the mainstay of assessment in the standard psychiatric memory clinic. Magnetic resonance imaging (MRI) tends to be available, but only as a ‘special treat’, often mediated by neurologists, and emission tomography, such as SPECT and PET, is only used in highly specialized cases outside a few academic centres. Apart from generic NHS austerity, ‘health without mental health’, and institutional ageism, what could be the reasons for this?