For many years the gold standard in diagnosing pneumonia has been the chest x-ray, both in clinical practice and for research purposes. The objective of this review was to examine the evidence to determine the role of chest x-ray in the diagnosis of pneumonia. A comprehensive literature search was conducted and abstracts were obtained from articles that, judged by their titles, bore relevance to the subject in question. Articles were selected for review based on their abstracts. Articles were subsequently reviewed, appraised and results were presented by grading evidence as Level I, II or III. Even the best available evidence failed to demonstrate improved outcome with the addition of chest radiography in ambulatory acute lower-respiratory infection in children. There is little evidence to justify the routine use of chest radiography in the diagnosis of pneumonia in children, but more research is needed to explore the potential benefit of chest radiography in specific clinical scenarios.