A Practical Resource for Healthcare Professionals
Across the UK, late diagnosis remains one of the biggest challenges in lung cancer care. At Roy Castle Lung Cancer Foundation, we are committed to supporting faster diagnosis and improving survival — and self-request chest X-ray (CXR) services are proving to be a powerful, practical intervention.
This page is a dedicated resource hub for healthcare professionals, commissioners and service leads who are interested in establishing a self-request CXR pathway in their area. Here you will find shared learning and Standard Operating Procedures (SOPs) from established programmes in:
LEEDS
The Leeds Self-Request Chest X-Ray (CXR) Programme provides direct access to chest imaging for eligible patients across the city with persistent chest symptoms, without the need for a prior GP consultation.
GREATER MANCHESTER
The Greater Manchester Self-Request Chest X-Ray (CXR) Programme provides direct access to diagnostic imaging for eligible patients registered with a GP in Bury, Heywood, Middleton or Rochdale.
LEICESTER
The Leicester Self-Referral Chest X-Ray Pilot is a targeted early diagnosis initiative currently available to eligible patients registered with GP practices in Coalville.
Our aim is simple: make it easier for more areas to adopt and adapt this effective approach.
What Is a Self-Request Chest X-Ray Service?
A self-request CXR service allows eligible patients — typically those over a specified age with relevant symptoms — to access a chest X-ray directly, without first needing a GP appointment.
These pathways are:
- Delivered in partnership with primary and secondary care
- Designed with clear safety-netting processes
- Supported by robust governance and reporting structures
- Targeted at increasing access for underserved and high-risk populations
When implemented effectively, self-request CXR services complement existing urgent suspected cancer pathways and lung cancer screening programmes.
Why Implement a Self-Request CXR Pathway?
1. Faster Diagnosis
Removing barriers to initial imaging helps identify lung cancer at an earlier stage, when treatment options are broader and outcomes are significantly better.
2. Reduced Pressure on Primary Care
By enabling direct access to imaging for defined symptom criteria, GP appointment demand can be reduced while maintaining safe clinical oversight.
3. Improved Equity of Access
Evidence from established services shows increased uptake among populations who may delay or struggle to access traditional routes to care — including people in deprived communities and those at higher risk of lung cancer.
4. Strong System Collaboration
Successful programmes demonstrate the value of collaboration between radiology departments, cancer alliances, primary care networks and public health teams.
Learning from Established Programmes
We are grateful to colleagues in Leeds, Manchester, and Leicester for sharing their documentation and experience.
Within this repository, you will find:
- Standard Operating Procedures (SOPs)
- Eligibility criteria examples
- Referral and reporting pathways
- Governance and clinical safety frameworks
- Communication materials
- Evaluation approaches and key metrics
These resources are intended to reduce duplication of effort and accelerate safe implementation in new areas.
Key Considerations for Implementation
While each locality will tailor delivery to its population and system structure, successful programmes commonly include:
- Clear inclusion and exclusion criteria
- Defined radiology capacity and reporting turnaround times
- Safety-netting and follow-up protocols
- Public awareness activity
- Data collection and evaluation plans
- Engagement with primary care and secondary care stakeholders from the outset
We recommend establishing a multidisciplinary steering group to oversee design, implementation and monitoring.
How Roy Castle Lung Cancer Foundation Can Support You
As the UK’s only lung cancer-dedicated charity, Roy Castle Lung Cancer Foundation works nationally to improve early diagnosis and patient outcomes.
We can support your area by:
- Sharing best practice and peer learning
- Advising on public engagement approaches
- Supporting awareness campaigns
- Connecting you with established services
- Amplifying impact through national advocacy work
Take the Next Step
Self-request chest X-ray services are a practical, evidence-informed intervention that can help diagnose lung cancer faster and save lives.
We encourage healthcare systems, cancer alliances and integrated care boards to explore adopting this approach and to make use of the resources shared here.
If you are developing — or considering developing — a self-request CXR pathway, we would welcome a conversation.
Together, we can remove barriers to diagnosis and ensure more people have the best possible chance of surviving lung cancer.