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Background: Chest X-rays are routinely requested for almost all preoperative patients in our local hospitals, regardless of their medical history, clinical examination, or clear indications. This practice is often justified by the belief that it can help stratify risk, guide anesthetic choices, or influence postoperative management. However, this high demand for chest X-rays places an excessive burden on healthcare system resources, increases exposure to ionizing radiation, and elevates the risk of false-positive findings.Objective: it is to assess the prevalence of incidental findings on preoperative chest X-rays in our city and their impact on surgical decision-making.Methods: This cross-sectional observational study included 260 patients admitted for elective non-cardiopulmonary surgery who underwent preoperative chest X-rays. We systematically analyzed each chest X-ray for abnormalities and classified them as either normal or abnormal. We also determined the consequences of these findings on the intended surgery (proceed to surgery, specialist referral before surgery without postponing the operation, or postponing the surgery).Results: Out of the total chest X-rays included in the study, 229 (88.1%) were reported as normal, and only 31 (11.9%) showed abnormalities. When assessing the impact on the decision to proceed with surgery, 257 (98.8%) of the patients underwent surgery without delay. For those with abnormal chest X-rays, they received specialist consultations without postponing their intended surgery. Only 3 patients (1.2%) experienced delayed surgery, and none of them had significant lung field abnormalities on their chest X-rays. The delays were attributed to other reasons.Conclusion: The use of chest X-rays should be justified on a case-by-case basis and limited to indicated patients based on thorough medical history and clinical examination, in alignment with published international guidelines. This approach will increase the efficacy of the healthcare system, reduce unnecessary costs, and ultimately enhance the safety and benefit for the patient.