The chest x-ray (CXR) remains one of the most commonly requested imaging studies, yet is one of the most complex and least understood, particularly the intensive care unit (ICU) bedside examination. In addition to deciphering numerous lines, tubes, lung and pleural findings of the AP (anterior-posterior) radiograph, critical care providers look to radiologists’ reports to summarize any pertinent changes in underlying pathological processes. This article will provide an overview of the bedside chest radiograph in the ICU setting, as well as a guide to effective reporting for the radiologist.