We analyzed surveys from 42 (91%) of 46 responding directors of pediatric emergency departments with fellowship programs to ascertain the scope of radiology services and the level of satisfaction. X-ray units but not computed tomography scanners were usually located on the same floor as the emergency department, but only 14 (33%) had imaging capacity within the department. In 67% of programs, emergency physicians provided the initial interpretation. Turnaround time varied from 30 minutes or less (31%) to 90 minutes or more (10%). Overall, 22 (52%) of the directors were satisfied with radiology services. A turnaround time of 45 minutes or less occurred more often with an x-ray unit in the department (P = 0.015), and directors tended to be more satisfied with this arrangement (P = 0.27). We conclude that the current state of the art consists of an x-ray unit in close proximity to the emergency department and a turnaround time of 60 minutes or less, but directors expressed more satisfaction with the service to their patients when a unit was in the department and turnaround time was shorter than 60 minutes.