Introduction : The utility of CXRs in ICU setting in Malaysia is variable with some centres practicing daily CXR strategy where as others practice on-demand strategy. The aim of this study was to compare both daily and on-demand CXR strategy and determine if the current practice of on-demand CXR can be safely continued without affecting the relevant clinical outcomes. Materials and method : This is a prospective cohort study of mechanically ventilated adult patients admitted to the intensive care units in HSB. The study period was from 1st April 2018 to 30th September 2018. Result : One hundred and sixty patients were recruited in both daily and on-demand CXR group respectively. There were no statistically significant difference in the duration of mechanical ventilation, ICU length of stay and mortality of the patients admitted to ICU in both groups (p=0.895). The mean percentage of CXR with new findings were significantly higher in the on-demand CXR group 83.5 compared to the daily CXR group which had only 38.8 (p<0.001). The mean percentage of CXR with new findings that prompted interventions was significantly higher in the on-demand CXR group compared to the daily CXR group, with a value of 83.9 and 34.9 respectively (p<0.001). Conclusion : In view of the low diagnostic and therapeutic yield of routine daily CXRs, we conclude that routine daily CXR practice can be safely abandoned in mechanically ventilated ICU patients. Keywords: Chest xray practice, Daily, On-demand, ICU