Examining patients in the intensive care unit (ICU) poses a substantial challenge, particularly when they are intubated. Alongside assessments, portable chest X-rays are commonly utilized. While portable chest X-rays have some limitations, they are accessible and cost-effective. They play a significant role in the routine assessment of critically ill individuals. Effective communication between radiologists and clinicians is crucial for enhancing interpretation accuracy and delivering quality care to these patients. As per guidelines from the American College of Radiology (ACR), portable chest radiography is recommended for patients experiencing symptoms of post-cardiac or -thoracic surgery trauma, those on life support devices, and critically ill patients. Recognizing that the chest examination process can differ based on whether the patient is lying down or standing up is essential. ICU pharmacists should understand the basics of critical care radiology to help optimize drug therapy plans for critically ill patients. When analyzing chest X-rays of ICU patients, a systematic approach is vital to prevent cognitive bias and ensure accurate interpretation.