Many surgical procedures involve the use of very small surgical needles. In the event that a postoperative needle count is incorrect, traditionally an x-ray has been taken to find the needle. Little data exist to recommend the smallest surgical needle that can be identified with conventional radiographic techniques and the optimum technique for finding lost surgical needles. In this quality assurance project x-rays of various size surgical needles were taken. The smallest seen by the majority of observers was 17 mm. The radiographic technique of choice for optimum detection of lost surgical needles was imaging with a mobile image intensifier.