Sedation for radiological imaging studies encompasses the majority of all sedation-related procedures outside of the intensive care unit. This review will follow the evolution of pediatric sedation for radiological imaging studies in North America as well as the transition of sedation services from the oversight of radiologists to those of other providers. The evolving options for sedation agents will be reviewed, with attention given to examining the advantages, limitations, and risks of replacing the standard sedatives with dexmedetomidine.