Chest radiographs are one of the most complex imaging modalities to interpret. The objective of this study was to assess how accurately emergency physicians interpreted chest radiographs in relation to radiologist reports. Radiological descriptions of chest radiographs from 667 emergency department (ED) patients, aged 14 to 84 years, were retrospectively reviewed. The overall level of agreement and agreement for different categories (congestive heart failure, pneumonia, and other) were assessed in 312 cases for which reports were available. Statistical analysis was done using the chi-square test, and interobserver agreement was calculated. The proportion of agreement between emergency physician and radiologist reports for normal, congestive heart failure, and pneumonia cases was 84.3%, 41.4%, and 41.4%, respectively. Emergency department physicians frequently missed specific radiographic abnormalities, and there was considerable discrepancy between their interpretations and those of trained radiologists. The agreement for some diagnostic categories such as pneumonia and congestive heart failure was low. This study's findings emphasize the need for improving interpretive skills among ED physicians.