How this fits in

Chest X-ray remains the first-line investigation for suspected lung cancer in the UK. Outcomes for lung cancer are relatively poor compared with the healthcare systems of many other advanced economies, which make more extensive use of other imaging modalities such as computed tomography (CT). This systematic review found that there is limited high-quality evidence published on the diagnostic accuracy of chest X-ray. The few high-quality studies identified suggest that chest X-ray misses (at least initially) lung cancer in >20% of people. As earlier diagnosis is closely associated with improved survival, it is therefore possible that the use of chest X-ray in UK practice may delay the diagnosis of lung cancer in some patients. These findings support calls to increase open-access CT for GPs, but, given resource restrictions and the potential to cause harm through overdiagnosis, further research is required to help identify which patients who have had a non-diagnostic chest X-ray should be referred for additional investigation.