Objective: The ACR has developed appropriateness criteria to ensure that patients are receiving appropriate imaging studies. The purpose of this study was to compare the imaging ordering practices of pediatric residents in specific clinical scenarios with the ACR Appropriateness Criteria®. Materials and Methods: A multiple-choice questionnaire was created using 10 clinical scenarios excerpted from the ACR Appropriateness Criteria. The questionnaire was sent to 69 pediatric residents (postgraduate years 1-3) at Children's Hospital of New York at Columbia University Medical Center (CHONY) and then to 75 pediatric residents at The Children's Hospital at Montefiore Medical Center (CHAM). The responses were compared with the ACR Appropriateness Criteria. Results: Seventy-five and 69 pediatric residents from the CHAM and CHONY, respectively, were invited to participate in the survey. Thirty-nine individual responses (52%) were received from CHAM, and 41 (59%) were received from CHONY. A total of 27 responses were received from first-year residents, 28 from second-year residents, and 25 from third-year residents. The average number of questions answered incorrectly by first-year residents was 4.1, by second-year residents was 4.4, and by third-year residents was 4.5. Conclusions: This study demonstrates that residents appreciate the value of an imaging workup, but these examinations are often ordered without the consultation of a radiologist. The decision each resident makes reflects individual training. To improve residents' ability to make decisions regarding imaging examinations, radiologists must educate pediatric residents with uniform case-based and didactic sessions.