The chest radiograph (CXR) is the most commonly ordered plain film in emergency medicine and has correspondingly broad indications. Patients who complain of chest pain have a broad differential diagnosis, and CXR is one of the first screening tests to be applied in chest pain complaints. CXR is useful to diagnose or identify primary cardiac and pulmonary pathology, abnormal pleural processes, thoracic aortic dilation, aspirated foreign bodies, and thoracic trauma. Pleural processes such as pleural thickening, pneumothorax, hemothorax, and pleural effusions are evident on CXR. CXR is the first radiologic screening test for thoracic aneurysm. Skeletal injuries, including rib, scapular, clavicular, shoulder, and sternal fractures and dislocations, can be seen on CXR. CXR identifies lung masses, pleural lesions, air-space disease, and hilar masses. However, the quality of these lesions is better delineated by CT. A consistent approach to the CXR improves detection of pathology.