Bone tumours are rare; primary bone sarcomas should be referred to specialist centres for investigation and management. Accurate diagnosis is usually achieved with history, clinical examination and plain radiographs. For bone tumours the patient's age, the site, size and location within the bone, margins, matrix and presence of periosteal reaction or soft-tissue extension all determine biological activity and the diagnosis. Other imaging modalities may supplement the radiological diagnosis but are of greater use in local and distal staging of the disease, surgical planning and surveillance. Biopsies are frequently guided by cross-sectional imaging but should be carefully planned in conjunction with the surgeon performing the definitive procedure. New radiological modalities are increasingly being used to support and supplement the management of musculoskeletal oncology patients.