Respiratory illnesses are among the top ten diagnoses for which children visit an emergency department and asthma, bronchiolitis and croup are the most common pediatric respiratory illnesses. Medical evidence suggests that CXRs are frequently used by emergency providers in children presenting for these conditions, yet CXRs rarely reveal information that leads to changes in management. Several studies also reveal significant variation in CXR use in asthma, bronchiolitis and croup in both children’s hospital and general emergency departments with higher utilization rates in the latter. Guidelines for CXR use are now available through the American Academy of Pediatrics and the medical literature for these conditions. This approach has been endorsed as a Choosing Wisely recommendation by the American Academy of Pediatrics Section on Emergency Medicine and the Canadian Association of Emergency Physicians. The Collaborative has adopted a utilization quality measure to reduce CXR use in children < 18 years with asthma, bronchiolitis, and croup.