A prospective study comparing the radionuclide skeletal survey with the radiographic survey was performed for 159 children with known primary neoplasms. Forty-four showed radionuclide evidence of metastases, while only 14 had radiographic evidence. Thus, 68% of metastases were discovered by bone imaging alone. No false negative images for metastases were obtained, though there was 1 false negative image for a primary tumor. Radionuclide skeletal survey is recommended as the primary evaluation for bony metastases in all children with neoplasms. Suspect areas should then receive complete radiographic examination.