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Introduction Intrapulmonary pathology, such as bullae or blebs, can cause pulmonary barotrauma when diving. Many diving courses require chest X-rays (CXR) or high-resolution computed tomography (HRCT) to exclude asymptomatic healthy individuals with these lesions. The ability of routine CXRs and HRCT to assess fitness to dive has never been evaluated. Methods Military divers who underwent yearly medical assessments at the Royal Netherlands Navy Diving Medical Center, including CXR at initial assessment, and who received a HRCT between