During the past decade, significant developments in surgical techniques, anesthesia, and intensive care have advanced and improved care of the sick newborn baby. All imaging modalities have reached a new higher level of sophistication, and the range of invasive and interventional radiology procedures has also greatly increased. These advances have placed greater demands on pediatric radiology departments, which must be well staffed, funded, and equipped to keep pace with these developments. Because of the plethora of available investigations, it is essential that both conventional radiographic and high-technology imaging facilities be used efficiently and rationally. A logical sequence of investigations should be applied, commencing with the simplest and least invasive, and where possible, minimizing exposure to ionizing radiation. At all times, the ALARA principle (as low as reasonably achievable) should be foremost in our mind. This approach may provide the diagnosis and obviate the need for more complex, invasive, and expensive studies, even if these additional modalities are readily available. Duplication of information obtained from these various imaging modalities, which does not improve or influence management of the patient, should be avoided.