In the medical image application the difference of intensity is widely used for the image segmentation and feature extraction, and a well known method is the threshold technique that determines a threshold value and generates a binary image based on the threshold. A frequently-used threshold technique is the Otsu algorithm that provides efficient processing and effective selection criterion for choosing the threshold value. However, we cannot get good segmentation results by applying the Otsu algorithm to chest X-ray images. It is because there are various organic structures around lung regions such as ribs and blood vessels, causing unclear distribution of intensity levels. To overcome the ambiguity, we propose in this paper an effective algorithm to extract pulmonary regions that utilizes the Otsu algorithm after removing the background of an X-ray image, constructs intensity-level maps, and uses them for segmenting the X-ray image. To verify the effectiveness of our method, we compared it with the existing 1-dimensional and 2-dimensional Otsu algorithms, and also the results by expert's naked eyes. The experimental result showed that our method achieved the more accurate extraction of pulmonary regions compared to the Otsu methods and showed the similar result as the naked eye's one.