Objectives To investigate the use of coned compression with and without magnification in contemporary Australian digital imaging. To describe lesion localisation techniques used for mammographic work up. Key findings As digital breast tomosynthesis becomes mainstream, the need for coned compression imaging has reduced, however the need for coned compression with fine focus magnification for assessment of microcalcification remains. Adapting film screen lesion localisation techniques to the digital setting is limited by the need for “true size” 1:1 ratio images for ease of measurement. Both the digital ruler and a grid technique can be used as an alternate. Conclusion Advances in image acquisition has evidenced a change in imaging protocols for suspicions lesions within the breast with breast tomosynthesis superseding the need for non-magnified coned compression views of the breast. Adaptation of the approaches to localising these lesions in the digital setting has also been necessary.