We evaluated right ventricular function in patients with pneumoconiosis using real-time three-dimensional echocardiography (RT3DE). A total of 80 consecutive patients were prospectively recruited, 44 of whom were diagnosed with pneumoconiosis, and the remaining 36 age-and gender-matched healthy volunteers served as the control group. All patients underwent both 2D and 3DE. The tricuspid regurgitation pressure (TRPG), right ventricular anterior wall thickness and range of motion, right ventricular posterior wall thickness and range of motion, right ventricular end-diastolic volume, right ventricular end-systolic volume, and right ventricular ejection fraction (RVEF) were measured. The RVEF of healthy volunteers ranged from 50 to 78%, while the RVEF of pneumoconiosis patients ranged from 29 to 73%. TRPG influenced RVEF by 77.3% (P = 0.006) and showed a negative correlation (r = -0.643, P < 0.01). Volume-time curves (VTC) of patients with pneumoconiosis showed more troughs (low stroke volumes) than the VTCs of normal subjects. Evaluation of right ventricular function in patients with pneumoconiosis using RT3DE can provide additional clinical information.