Abstract: Objective To summarize clinical characteristics and X-ray imaging features of the first diagnosed pneumoconiosis patients. Methods The data of 242 first diagnosed cases from January 2009 to December 2013 in hospital were analyzed. Results All of the cases were male, among them 109 cases at stage 1(45.04%),87 cases at stage 2(35.95%),46 cases at stage 3(19.01%). Most cases were silicosis and potter's pneumoconiosis. The average age of onset was (43.25 ±7.39)years old and the average dust exposure time was(9.92 ±5.27)years,and there was no statistical significance on age and exposure time among cases diagnosed at different stages (F=0.719,2.570,P>0.05). There was statistical significance on the occurrence of shortness of breath among different stages(χ²=15.586,P<0.05). Pulmonary function injury rate and small airway function damage rate increased with the severity change varied from stage 1 to stage 3(χ²=4.032,5.550,P<0.05). The major type of pulmonary function damage was restrictive injury (accounting for 72.09%). The occurrence of complication as tuberculosis was low(1.65%). The most prominent X-ray image was the presence of small round opacities(98.76%,239/242)and majority was "q" shadow (78.24%,187/239). The small opacities were mostly distributed in the middle lobes(40.19%,461/1 147). Large shadows were mostly distributed in the right upper lung zones(47.95%,35/73)with round or oval form. Conclusion In Guangdong Province new pneumoconiosis cases were mostly silicosis and potter's pneumoconiosis. The enterprises should improve working environment to prevent pneumoconiosis.