Imaging of severely injured patients within the context of major trauma can present many challenges. The initial imaging of trauma patients usually occurs within these specialised centres; a small number may present to other hospitals; it is vital that in these cases patients are managed quickly and safely. The decision to perform imaging should be made in conjunction with the lead trauma physician. Many major trauma patients are unable to provide an accurate medical history and a clinical decision may need to be made in the best interest of the patient given the potential for significant internal injury. Penetrating injuries include stabbings and gunshot wounds, but they may also be sustained in conjunction with blunt injuries depending on the mechanism of injury. Sagittal and coronal reformat assessment is essential in cases of penetrating trauma to correctly identify the trajectory of the wound. Thoracic trauma can result in severe, life-threatening injuries that need rapid diagnosis and treatment.