Of 100 consecutive patients of 70 or more years of age who presented for elective surgery, only 27 were considered to lack a medical indication for chest X-ray. Of these 27, 10 patients had abnormal findings on the X-ray. These figures suggest that routine pre-operative chest X-rays in elderly patients are well worthwhile, and that the savings made by abandoning the practice would be more than outweighed by potential delays and disruptions to theatre lists and the loss of relevant information.