To determine U.S.-based radiologic technologists' perceptions of imaging appropriateness by imaging modality and to examine relationships between descriptive variables and perception of imaging appropriateness scores. A cross-sectional survey was used to collect data and guide testing of the hypotheses. Radiologic technologists working in radiography, computed tomography, and mammography were eligible to participate in the study. The survey instrument items were evaluated for validity and reliability. Categorical and descriptive data were calculated, and 1-way analysis of variance tests were used to analyze hypotheses. Survey results found that the radiologic technologists perceived that 16% to 30% of completed examinations were inappropriate, with the primary reasons being fear of lawsuits and patient expectations. Technologists indicated that imaging ordering should be based on the effect that an imaging procedure can have on the patient's diagnosis or treatment. The study found 6 main effects with mean differences between groups for the perception of imaging appropriateness score, including primary employed imaging modality (P < .001), shift length (P < .001), work shift (P < .001), primary practice facility (P < .001), primary patient population (P = .009), and level of education (P = .044). Employment status, primary role, age, years of experience, number of imaging credentials, gender, and practice location were not significant at the level of P ≤ .05. Study findings demonstrate the complexity and interconnectedness of imaging appropriateness, the potential reasons driving ordering practices, and the importance of increasing radiologic technologists' familiarity with appropriate use criteria. Further, the results show the importance of using clinical decision support mechanisms and ensuring that potential risk from ionizing radiation exposure remains a core component of the decision-making process when choosing among imaging examinations of similar diagnostic value. Further research needs to be conducted to better understand perceptions of imaging appropriateness, how perceptions align or deviate from appropriate use criteria, and improvements in imaging appropriateness from enhanced radiologic technologist-provider collaboration.