Routine daily chest radiographs (CXR) in intensive care units (ICUs), including cardiovascular (CVICUs) and cardiothoracic (CTICUs), are widely used for early complication detection during the post-operative period. However, evidence suggests that this practice lacks clinical utility, with low diagnostic and therapeutic yields. The evidence consistently demonstrates that an on-demand CXR strategy, performed only for specific clinical indications, offers comparable patient safety, reduced radiation exposure, and substantial cost savings without increasing adverse outcomes, ICU length of stay, or mortality. For post-cardiothoracic surgery patients, complications such as pleural effusions and pneumothoraces are of important concern, yet routine CXRs rarely identify such abnormalities, with very few requiring intervention. Data support an on-demand approach, even after procedures such as chest tube removal, as clinical signs and symptoms are reliable indicators of complications. Transitioning from routine to on-demand CXR practices aligns with evidence-based guidelines, including Choosing Wisely® and the Critical Care Societies Collaborative recommendations. This approach promotes high-value care, minimizes unnecessary imaging, and supports the safe, cost-effective management of ICU patients. Routine CXRs should be reconsidered as standard practice in favor of tailored, patient-specific imaging strategies. © 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.