Purpose: MRI examinations in children under sedation or general anesthesia are a multidisciplinary challenge for pediatric, radiology and anesthesiology departments. This article presents findings about patient population, anesthesiology procedures and process times in pediatric MRI procedures under sedation or general anesthesia. The analysis is focused on the potential to optimize process times. Materials and Methods: Retrospectively over a 5-year period, data from diagnostic radiology procedures in children requiring sedation or general anesthesia were retrieved from anesthesia records and analyzed statistically. Results: The median anesthesia time in patients without an airway device was 6 min. In patients with a laryngeal mask (19 min) and in patients receiving endotracheal intubation (20 min), the anesthesia time was significantly longer (p < 0.001). The need for airway management in the age groups was 67 % for neonates, 25 % for infants, 8 % for toddlers and 7% for school children. Improved clinical pathways could potentially save additional time up to 69 hours in our period of investigation. Conclusion: In relation to older children, toddlers, infants and neonates had the longest process times in diagnostic radiology procedures, caused by the need to secure the airway. Improved pre-MRI processes have an enormous potential to generate additional examination time.