The objective of this study is to know the relationship between MDR-TB treatment to the changes in diameter and thickness of cavity wall on chest X-ray (CXR) 6 month and 12 months post treatment. This study was conducted in MDR-TB clinic in Kariadi Hospital, Semarang on January 2013-December 2016. We examine cavitary lesions, evaluated with CXR in pulmonary MDR-TB patients before and after 6 and 12 months of treatment course. Subjects who had been diagnosed as pulmonary MDR-TB and had received MDR-TB treatment for at least 12 months were chosen. Subjects characteristics and cavities features i.e. cavity number, diameter and wall thickness from initial and follow-up CXR 6 and 12 months of treatment were retrieved. A total of 43 patients of MDR-TB, consisted of 22 males and 21 females, was recruited. Most of the subjects aged 31-50 year old and presented with single cavity. The cavitary lesions showed significant reduction over 6 and 12 months of follow up based on CXR (p<0.001) for both diameter and wall thickness. Both diameter and wall thickness changed significantly from initial to 6 months (r=-0.87, p<0.001), initial to 12 months (r=-087, p<0.001), and 6 months to 12 months (r=-0.84, p<0.001), respectively. In conclusion, CXR as a useful diagnostic instrument that can be used to evaluate pulmonary TB, in primarily low resource setting.