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Introduction: Chest x-ray (CXR) is the primary modality for diagnosis and severity assessment and monitoring the ATT response in pulmonary tuberculosis (PTB). The aim of our study was to determine the correlation between the radiographic involvement of disease on CXR based on Timika CXR score with the clinically and bacteriological specications at diagnosis and initiation of ATT in sputum smear-positive PTB patients. Material And Method: A cross-sectional study was conducted in the Department of Pulmonary Medicine, a tertiary care hospital, Punjab, from January to June 2020. Seventy new sputum smear-positive cases of PTB were included. At the time of diagnosis, the patient's baseline test, clinical signs and symptoms were evaluated using TB scores I, II, Karnofsky performance score (KPS), and body mass index (BMI). Two chest physicians, according to the Timika CXR score, evaluated the CXR of each patient Independently. Result: Cavitary lesion on CXR resulted in a signicantly higher Timika score associated with higher Mycobacterial load in sputum grading compared to non-cavitary disease. 55.17% of patients with CXR score ≥71 had statistically signicant higher baseline sputum grading compared to 9.76% of patients with CXR ≤ 71. Higher Timika CXR score ≥ 71 was signicantly associated with a longer mean duration of symptoms, lower BMI, higher TB score, lower KPS at baseline, higher ESR, low hemoglobin, low serum albumin. Discussion: The study shows that Timika CXR score signicantly correlates with radiographic involvement and extent of disease severity on CXR with the clinically and bacteriological prole of PTB patients, which a pulmonologist can use in a medical practice. A Higher CXR Timika score is associated with the patient's poor clinical condition and the severity of the disease. Cavitary lesion on CXR associated with higher sputum smear grading. It is observed that the Timika CXR score can be used to identify the PTB patients at risk of treatment failure for their more aggressive management.