We evaluated the usefulness of roentgenographic tracheal tube cuff shadow to tracheal wall diameter ratio (CTW ratio) and cuff minus tracheal diameter difference (C-T diameter) in estimating intracuff pressure (ICP) in intubated and mechanically ventilated patients. Seventy-one measurements of ICP, CTW ratio and C-T diameter were obtained from 20 mechanically ventilated male patients intubated with high volume low pressure cuffs in the surgical and medical intensive care units. The mean age was 61 years (range 30 to 83 years). ICP was measured by one observer, while CTW ratio and C-T diameter was measured by another observer. No significant relationship was seen between ICP and CTW ration (r = 0.092, p = 0.873), or between ICP and C-T diameter (r = 0.093, p = 0.42) by linear regression analysis. In conclusion, roentgenographic estimation of ICP by portable plain chest films in intensive care units was not found useful in this study.