OBJECTIVE--To assess the ability of radiographers to identify abnormal radiographs of patients attending accident and emergency departments. DESIGN--Prospective study over six weeks. SETTING--Teaching hospital casualty x ray department. PATIENTS--3394 consecutive patients referred for radiography. INTERVENTIONS--Radiographs were assessed by radiographers who were offered a four point triage scheme: normal, abnormal, insignificantly abnormal, or further advice required. MAIN OUTCOME MEASURES--Comparison of radiographers' assessments with an assessment made independently by the reporting radiologists. RESULTS--Overall disagreement between the radiographers and radiologists was 9.4%. There were 7% false positives and 14% false negatives. Most errors occurred in assessing radiographs of the skull, facial bones, chest, abdomen, and soft tissues. CONCLUSION--Unselected radiographers can offer useful advice on radiographs to casualty officers, but their high rate of false positive diagnoses indicates that they cannot triage casualty radiographs sufficiently accurately to allow them to extend their current reporting role.