Pediatric interventional radiology procedures are becoming increasingly common in the medical community, in part due to the significant medical benefit derived from these studies. At the same time, the medical radiation used for these studies contributes to the radiation dose to this unique population of patients. As children are more sensitive to radiation than adults and have a longer lifetime to manifest those changes, a concerted effort should be made toward radiation protection in this setting. Pediatric interventional procedures may differ from adult examinations in several ways, including the small size of the patient, the proximity of the operator's body and hands to the beam, and small body spaces resulting in precarious wire purchase. We describe specific strategies to improve patient and staff safety. These include staff education, safety checklists, a team approach, and formalized review and quality assurance programs. Practical steps to reduce patient dose are reviewed, and tools to assist in achieving the goal of optimizing radiation safety in children undergoing interventional procedures are provided.