Background: Routine daily chest X-rays (RXR) are now replaced by an on-demand radiographic policy to decrease the hazards of radiation and avoid unnecessary movements of patients. However, this may miss possible serious conditions in critical patients. Repeated X-rays at patient admission, may be needed to help follow up of patient's condition and avoid misdiagnosis. Objectives: This study aimed todetermine the major radiological abnormalities of the repeated chest x-ray and their impact on the management of intensive care unit (ICU) patients.  Methods: A prospective study was conducted on 110 patients in ICU and/or mechanically ventilated (74 adult and 36 pediatric) at The Adult and Paediatric ICU in Menoufia University Hospital through the period from January 2021 to March 2022. Results: The most common initial radiographic findings among the studied cases were consolidations (n=26 / 23.62%) and pleural effusion (n=25 / 22.7%). On release, most of the studied cases showed improvement (n=40/ 36.36%). After line placement, consolidation was the most common chest X-ray finding (n=26 /23.6%) and on the second follow-up (n=24/ 21.8%). The most common clinical approach among the studied cases was requesting further advanced imaging techniques (CT chest, CT pulmonary angiography & chest US), (n=40/47.62%), followed by no change in management plan (drug therapy) that was found in 30 cases (35.71%). Furthermore, 84 patients showed improvement of clinical condition in the ICU and were released either to the intermediate ward, to a medical department or to complete treatment at home. 58 of them were still showing consolidation (69.06%), 10 patients (11.90%) showed effusion, and 16 patients (19.05%) showed atelectasis. Conclusions: The repeated radiographic evaluation of patients in ICU is initial to monitoring devices used because the potentially serious complications arising from their introduction and use are often not clinically apparent. Also, repeated chest x-rays are helpful to detect other serious chest conditions that may be missed during patients' follow-ups. Chest x-ray before the patient's release helps in expecting the patient's condition and avoiding any unexpected problems after the patient's release.