A pediatric MRI service is a vital component of a successful radiology department . Building an efficient and effective pediatric MRI service is a multifaceted process that requires detailed planning for considerations related to finance, operations, quality and safety, and process improvement . These are compounded by the unique challenges of caring for pediatric patients, particularly in the setting of the recent coronavirus disease 2019 (COVID-19) pandemic . In addition to material resources, a successful pediatric MRI service depends on a collaborative team consisting of radiologists, physicists, technologists, nurses and vendor specialists, among others, to identify and resolve challenges and to strive for continued improvement . This article provides an overview of the factors involved in both starting and optimizing a pediatric MRI service, including commonly encountered obstacles and some proposed solutions to address them.