All Accident and Emergency departments in England seeing more than 20,000 new patients each year were surveyed for the extent and mechanism of their radiological reporting service. A total of 190 of the 210 departments replied, 39% of these departments were not satisfied with the service available to them. A 'hot' reporting service was available in 2.6% of departments and 49% did not have films reported in under 48 h. The methods used to detect radiological abnormalities missed by the A&E doctor were investigated further. A total of 60% of departments had a traditional reporting system but 29% had introduced systems that required the A&E doctor to include his or her radiological diagnosis with the films prior to their being returned to the X-ray department for reporting. This allowed rapid audit of radiological assessment. Its introduction to all A&E departments is recommended.