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OBJECTIVE: To assess the role of conventional plain X-rays in managing fish bone impaction in throat, after eating commonly consumed species of fish in Pakistan. METHODS: This cross-sectional descriptive study was conducted at Combined Military Hospital Muzaffarabad, Pakistan. X-ray of bones from eight different species of commonly eaten fish were taken (in-vitro) and then compared to X-ray of same bone kept in oral cavity of a volunteer (in-vivo), in order to assess the effect of soft tissue and bony super imposition on radio opacity of fish bone and its clinical impact. The radiographs were taken using Siemens 500 MAS machine with an exposure of 65 kV for adults. Both the in vitro and in vivo radiographs were reviewed by thirty doctors of varied echelons ranging from interns to consultants of varying specialties (ENT, Radiology, Internal medicine, general surgery). RESULTS: Bones of seven fish species were 100% identified on in-vitro film while one fish type (drum fish) was identified by 93.3% (n=28/30) observers. Whereas, in-vivo identification of same bones ranged from 0.00% to a maximum of 33.33%. On in-vivo films, the maximally visualized fish bones were Mahseer and Butter fish (n=10/30; 33.3% each) followed by Catla/Indian carp, Eel, Pomfret and Cobia (n=5/30; 16.6% each). Croaker/drum fish could not be visualized by any observer on in-vivo films. CONCLUSION: Conventional plain X-rays alone cannot be relied upon for diagnosing fish bone impaction in upper aero-digestive tract. [ABSTRACT FROM AUTHOR]