BackgroundWorkload among pediatric radiologists is rising, driven by staff shortages, case complexity, and call demands. Higher imaging volumes are linked to diagnostic errors and job dissatisfaction, affecting patient care and radiologists’ retention and recruitment. Technological advances may have increased the number of images generated per study, contributing a hidden workload not captured by study counts alone.ObjectiveTo determine the increase in the number of images per study in pediatric ultrasound (US), computed tomography (CT), and magnetic resonance (MR) at a pediatric tertiary care hospital between 2004 and 2023.Materials and methodsA single-center retrospective review was conducted on the number of images acquired in select US, CT, and MR studies for patients under 18 years during the week of June 1-7, from 2004 to 2023. Trends were assessed with linear regression, with statistical significance at a P-value of <0.05.ResultsA total of 1,751 studies were reviewed and 749,152 total images were analyzed. The average number of US images per study increased from 38.67 to 165.24, MR from 185.62 to 1,292.00, and CT from 42.53 to 266.00. Regression analysis indicated statistically significant increases in all modalities: US by 7.41 images per year, MR by 51.60, and CT by 22.27 (P<0.0001 for all). Stratification based on study subtype was also performed.ConclusionThe number of images per study has significantly increased over the two decades, adding hidden strain on pediatric radiologists’ workload. Imaging protocols should be reviewed to optimize the number of acquired images without losing diagnostic accuracy.