A shift toward more sustainable imaging practices is essential to reduce the ecological footprint of diagnostic radiology while maintaining high standards of patient care. Knee MRI targeted application in patients over 50 remains vital for specific indications. Clinicians must prioritize radiographs as first-line imaging and reserve MRI for scenarios where it directly informs therapeutic decisions. Adherence to ACR appropriateness criteria (6), wich can be achieved using the ESR iGuide is crucial to optimize diagnostic accuracy, foster equitable resource allocation, and support the long-term sustainability of radiological services. Efforts to reduce overuse include also improving physician education as well as leveraging advanced technologies like deep learning.