Objective To explore the values of high kilovoltage chest radiograph(HKV), digital X-ray imaging system(DR)and high-resolution CT(HRCT)in the diagnosis of pneumoconiosis. Methods 184 patients suspected with pneumoconiosis in Hunan Prevention and Treatment Institute for Occupational Diseases were examined by HKV, DR and HRCT techniques,and the results were compared. Results HKV and DR were not significantly different in the diagnosis of pneumoconiosis. However, the rate of grade-I film of DR chest film(91.30%)was statistically higher than that of HKV(63.04%,P0.05). HRCT was superior to HKV in the diagnosis rate and determination of pneumoconiosis complications in stage 1 and 3 of pneumoconiosis. Conclusions DR is better than the conventional HKV in technical quality in dignosing pneumoconiosis.HRCT is of great importance in the early detection of pneumoconiosis, diminutive shade aggregation and in the diagnosis of pneumoconiosis complications.