Guidance for urgent referral for a chest X-ray

Indications for an urgent referral for a chest X-ray include guidance from NICE has been updated (1).

There is no longer mention of symptoms or signs being persistent (that is lasting more than 3 weeks) as in previous guidance. Also the guidance relates to patients aged over 40 when there was no age discrimination in previous guidance (2). Unexplained haemoptysis in patients over 40 years of age is considered criteria for 2 week referral (1).

An urgent chest X-ray should be offered (to be performed within 2 weeks) to assess for lung cancer in people aged 40 and over if they have 2 or more of the following unexplained symptoms, or if they have ever smoked and have 1 or more of the following unexplained symptoms:

• cough
• fatigue
• shortness of breath
• chest pain
• weight loss
• appetite loss

An urgent chest X-ray should be considered (to be performed within 2 weeks) to assess for lung cancer in people aged 40 and over with any of the following:

• persistent or recurrent chest infection
• finger clubbing
• supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
• chest signs consistent with lung cancer
• thrombocytosis

An urgent chest X-ray should be offered (to be performed within 2 weeks) to assess for mesothelioma in people aged 40 and over, if:

• they have 2 or more of the following unexplained symptoms, or
• they have 1 or more of the following unexplained symptoms and have ever smoked,
• or they have 1 or more of the following unexplained symptoms and have been exposed to asbestos:
  • cough
  • fatigue
  • shortness of breath
  • chest pain
  • weight loss
  • appetite loss

Consider an urgent chest X-ray (to be performed within 2 weeks) to assess for mesothelioma in people aged 40 and over with either:

• finger clubbing or
• chest signs compatible with pleural disease

Reference:

1. NICE (January 2015). Suspected cancer - recognition and referral
2. NICE (February 2005). Lung cancer - the diagnosis and treatment of lung cancer