How do general practitioners respond to reports of abnormal chest X-rays?

General practitioners (GPs) in the UK have long had direct access to hospit al radiological services, which in theory shortens investigation time and i mproves the quality of service. Chest X-rays (CXRs) account for a substanti al proportion of requests, and we investigated what happened when an abnorm ality was detected. In one year, 204 GPs in the Nottingham area requested CXRs in 605 patients. 362 were reported normal, 165 abnormal but hospital follow-up not indicate d and 71 abnormal with radiological follow-up or hospital referral indicate d (mass lesion suspicious of tumours 27, infective shadowing 35, other 9). 64 of the 71 were seen in hospital within three months, and in those with s uspected cancer the median time to follow-up was 20 days. These results show that GPs do act on the results of abnormal CXRs, but onl y 37% of those with a mass suspicious of cancer were seen in hospital withi n two weeks as recommended by the British Thoracic Society. Time might be s aved if GPs agreed to direct referral from the radiology department to resp iratory physicians.