Radiography has provided clinicians with the ability to detect subtle nuances and confirm overt and covert diagnoses. This article outlines a systematic approach to interpreting a chest radiograph for the advanced practice nurse practicing in an emergency department setting. Accurate interpretation of a normal versus an abnormal pediatric chest radiograph requires a standard, thorough approach by the clinician. The clinician should choose the best radiographic view based on age, compliance, history of present illness, and physical examination findings. The importance of interpreting a chest radiograph in a systematic manner avoids an approach that may lead to misdiagnosis. Collaboration with a physician ultimately ensures a safe diagnosis and effective treatment. © 2006 Lippincott Williams & Wilkins, Inc.