<p>Healthcare operations are a major contributor to human-produced greenhouse gas emissions worldwide and in the USA in particular. Medical imaging, largely due to its high energy use requirements, disproportionately contributes to healthcare’s negative environmental impacts. Although there has been growing concern about radiology’s role in climate change, most existing knowledge of radiology’s impact derives from adult radiology departments. Pediatric radiologists, however, have compelling reasons to consider and work to reduce our specialty’s contributions to climate change: our pediatric patients are uniquely vulnerable to the negative effects of climate change and face wide-ranging impacts to their overall health and well-being. The aim of this manuscript is to review the major environmental impacts from radiology and to highlight potential areas for improvement.</p>