An anthropomorphic phantom study was carried out in 2013-14 in two hospitals, one located in Russia (Mariinsky Hospital, Saint Petersburg) and the other in Sweden (Skåne University Hospital, Malmö). The aim of the study was to investigate the possibilities to reduce the patient dose from digital X-ray chest screening examinations. The existing chest imaging protocols were adjusted by changing the tube voltage, total filtration and grid in order to determine the most dose-effective combination of the examination parameters. It was possible to achieve up to 50 % dose-area product (DAP) and 30 % effective dose reduction by raising the tube voltage from 100 to 125 or 150 kV, and simultaneously decrease the total filtration to the minimum allowed by the X-ray unit (3 mm Al). The absence of a grid allowed to further reduce the DAP and effective dose by up to 80 %. Comparison between Russian and Swedish X-ray units showed the same trend in DAP and effective dose reduction, but the absolute dose values were lower by almost a factor of 10 for the Swedish units due to different image receptors and automatic exposure control settings.