SETTING Report of a workshop on Occupational Lung Diseases, IUATLD Respiratory Disease Section, Bangkok 1998. OBJECTIVE To describe the role of chest radiography in the diagnosis of pneumoconiosis in clinical practice. MATERIALS AND METHODS Pneumoconiosis, defined as the accumulation of dust in the lung and tissue reaction to its presence, is diagnosed and monitored by X-ray techniques. The International Labour Organization (ILO) developed a descriptive system of the radiographic appearances of pneumoconiosis using standard chest radiographs to classify the type and category of profusion of small opacities seen in the lung fields, as well as the width and extent of pleural changes and other abnormalities of a more general nature. RESULTS The pertinence of the ILO classification has been demonstrated by studying the correlation between anatomic lesions and chest X-ray features. Other imaging techniques have been proposed over the past few years, including computed tomography and magnetic resonance imaging. However, until now they have remained essentially complementary to verify an unclear aspect of particular features of a given radiograph, rather than as the standard method of diagnosis. CONCLUSION Chest radiography remains the principal tool in the diagnosis of pneumoconiosis, and has the advantages of the large number of units in service throughout the world, their relatively low cost, and the widely-accepted ILO classification.