The use of medical imaging is commonplace in children with otolaryngologic disease, with a not insignificant and increasing exposure to ionizing radiation from such diagnostic imaging. Radiation exposure imparts potential cancer risk, particularly in children, who have long life expectancies and are more sensitive to the adverse effects of ionizing radiation. We summarize these issues, with a focus on computed tomography (CT) in children. The otolaryngologist plays a key role optimizing the use and minimizing the risk of diagnostic imaging in children by ordering the correct test at the best time for the right reasons. In concert with radiology colleagues and informed parents, we can improve the safety of radiologic imaging for the children we diagnose and treat.