Chest radiography remains the cornerstone of diagnostic imaging globally, functioning as a primary triage and diagnostic tool for a diverse array of cardiopulmonary pathologies, particularly tuberculosis and pneumonia. In resource-constrained environments like Cameroon, healthcare systems exhibit an extreme reliance on chest radiography; however, the structural frameworks necessary to optimize image quality and minimize patient radiation dose are frequently inadequate. This narrative review evaluates the clinical relevance and practical implementation of stringent European image quality guidelines specifically the EUR 16260 anatomical criteria and the European Union Directive 2013/59/Euratom within the Cameroonian context. The analysis synthesizes current methods of image quality assessment, encompassing visual grading analysis, reject and repeat audits, standardized exposure indices (IEC 62494-1), and the integration of artificial intelligence tools such as CAD4TB. Translating European standards to Cameroon encounters profound structural barriers, driven primarily by a critical shortage of radiological personnel, with a radiologist density of approximately two per million inhabitants compared to the European average of 127 per million. Additional friction points include the unmonitored transition from analogue to digital radiography, the inconsistent application of Diagnostic Reference Levels (DRLs), and the limited enforcement capacity of the National Radiation Protection Agency (ANRP). Despite these systemic hurdles, strategic opportunities exist to elevate diagnostic standards. Expanding teleradiology networks to support remote facilities, implementing low-cost quality assurance audits, and leveraging artificial intelligence for automated image assessment offer viable solutions to bridge the quality gap. The establishment of localized DRLs and the prioritized training of radiographers and medical physics experts stand as essential prerequisites for achieving sustainable diagnostic excellence and radiation safety in Cameroon. Establishing routine diagnostic reference levels for standard procedures is a universally recommended practice for adhering strictly to the ALARA principle.