Abstract: Objective The pulmonary image characterization of 60 pneumoconiosis checked by HKV chest radiograph and DR chest X-ray were compared to evaluate the diagnostic value of DR chest X-ray. Methods A total of 60 pneumoconiosis patients with stage 1 diagnosed with HKV chest radiograph were examined again with the DR chest radiograph. Their pulmonary image characterization was compared based on the diagnosis criterion of pneumoconiosis in China. Results DR chest radiograph had obvious advantage in the judgment of resolution of lung texture, compared with HKV chest radiograph(χ²=28.138,P<0.01);There was high consistency of these two radiographs to show the small shadow form, the overall intensity and the number of involved lung areas (Kappa values 0.767,0.659 and 0.490, respectively). 2 cases could be diagnosed as pneumoconiosis with stage 2, based on the overall intensity shown in the DR chest radiograph. Some other cases showed more numbers of involved lung area in the DR chest radiograph compared with HKV radiograph. Conclusion There was high consistency of DR chest radiograph in the diagnosis of pneumoconiosis with stage 1, compared with HKV chest radiograph. DR chest radiograph could provide valuable clinical data for the diagnosis of pneumoconiosis with stage 1.