Patient guide · Pulmonary screening
Lung health check, NHS Targeted Lung Health Check — LDCT screening plus lifestyle review for smokers 55-74.
The NHS Lung Health Check is offered to people aged 55-74 with a smoking history. Includes a symptom review, spirometry, low-dose CT and personalised smoking-cessation and lifestyle advice. Reduces lung cancer mortality by ~20%.
Reviewed by Pulse Atlas Editorial Board () · Last reviewed 2026-07-30 · Next review 2027-07-30 · 5 min read
Why it matters
- 01
Catches cancer early
The NHS Targeted Lung Health Check programme has been shown to reduce lung cancer mortality by around 20% in eligible smokers and ex-smokers.
- 02
More than a scan
A symptom review, spirometry, low-dose CT and personalised advice on smoking cessation, inhaler therapy and cardiovascular risk — in a single pathway.
- 03
MDT-linked and structured
Every scan is reviewed against Lung-RADS and, if suspicious, fed directly into the two-week-wait multidisciplinary team pathway.
Key facts
The lung health check in six lines.
A quick, plain-English summary of the pathway, who it is for, and what the scan involves.
| Fact | Detail |
|---|---|
| Definition | NHS Targeted Lung Health Check with low-dose CT (LDCT) screening plus lifestyle review. |
| Who it is for | Adults aged 55–74 with a current or previous smoking history. |
| What is included | Symptom review, spirometry and a low-dose CT scan of the chest. |
| Radiation dose | Low-dose CT delivers approximately 1.5 mSv — a fraction of a standard chest CT. |
| Onward pathway | Every result is reviewed by a multi-disciplinary team, with structured follow-up or 2WW referral if needed. |
| Wider impact | Cross-links directly with smoking-cessation, cardiovascular-risk and COPD services. |
Preparation
What to expect, step by step.
From invitation to structured plan — the scan itself takes only a few seconds.
Phase 1 · Before your check
Invitation and eligibility review
Phase 2 · On the day
Symptoms, spirometry and LDCT
Phase 3 · After
Lung-RADS report and plan
- 01
Before
Eligibility invitation
You are invited via the NHS Targeted Lung Health Check programme, or self-refer privately, based on age and smoking history.
- 02
Before
Telephone or clinic review
A trained clinician takes a full smoking, occupational and family history to confirm eligibility and explain the pathway.
- 03
On the day
Symptom assessment
A focused review of cough, breathlessness, weight loss, haemoptysis and any red-flag features on the day of the check.
- 04
On the day
Spirometry
A short breathing test that measures airflow — flags underlying COPD or restrictive lung disease alongside the scan.
- 05
On the day
Low-dose CT scan
A few seconds of scanning in a modern CT — no needles, no contrast, and a radiation dose of around 1.5 mSv.
- 06
After
Radiologist report per Lung-RADS
Images are read by a consultant chest radiologist and classified using the Lung-RADS reporting standard.
- 07
After
Structured plan
A personalised plan — reassurance, nodule surveillance, smoking-cessation support, inhaler review or 2WW referral.
What it shows
What a lung health check can pick up.
The primary target is early lung cancer, but the LDCT and spirometry together surface COPD, ILD, cardiovascular risk and important incidentals.
-
Lung cancer (early stage)
The primary target — small, potentially curable tumours picked up before symptoms develop.
-
Solitary or multiple nodules
Pulmonary nodules classified by size and morphology, followed with Fleischner-guided surveillance if benign-appearing.
-
Emphysema
Areas of lung destruction that quantify smoking-related COPD alongside the spirometry result.
-
Interstitial lung disease
Reticulation, honeycombing or ground-glass suggesting fibrotic or inflammatory lung disease.
-
Coronary calcium (incidental)
Calcification of the coronary arteries — a strong cardiovascular-risk marker seen incidentally on the scan.
-
AAA (incidental)
The upper abdominal aorta is included on many LDCT protocols, allowing incidental aneurysm detection.
-
Spirometry pattern
Obstructive, restrictive or mixed spirometry findings that guide inhaler therapy or further pulmonary testing.
-
Red flag: Lung-RADS 4B/X — 2WW pathway
A highly suspicious finding triggers the two-week-wait cancer pathway with rapid respiratory-MDT review.
Next steps
What happens after your lung health check.
The pathway depends on scan and spirometry findings — from reassurance and cessation support to nodule surveillance and MDT referral.
-
Reassurance if negative
A normal scan and spirometry are highly reassuring — routine re-screening intervals are then set based on programme guidance.
-
Fleischner nodule surveillance
Small, benign-appearing nodules are followed with interval CT scans according to Fleischner Society guidance.
-
Smoking cessation support
Every attendee is offered evidence-based cessation support — behavioural counselling and pharmacotherapy — regardless of scan result.
-
Pulmonary rehabilitation
Structured exercise, education and breathing programmes for patients with symptomatic COPD or reduced exercise tolerance.
-
Inhaled therapy for COPD
For confirmed COPD, appropriate inhaler therapy is initiated or optimised in line with NICE and GOLD recommendations.
-
Cardiovascular risk optimisation
Incidental coronary calcium prompts a full CV risk review — blood pressure, lipids, glycaemia and statin discussion.
-
Onward MDT if suspicious
Lung-RADS 4A/4B/4X findings are discussed at the lung-cancer MDT with a fast-track biopsy or PET-CT plan.
-
Structured follow-up
Every attendee leaves the pathway with a written plan, a named clinician and a clear re-contact date.
Red flags
When lung findings become urgent.
These are the presentations that warrant fast-track — sometimes 2WW or same-day — action rather than a routine follow-up.
-
Spiculated mass
A spiculated pulmonary mass on LDCT is highly suspicious for malignancy and warrants urgent 2WW referral.
-
Bulky mediastinal disease
Enlarged mediastinal or hilar lymph nodes suggest advanced disease and mandate rapid MDT and staging assessment.
-
Rapid symptom change
New haemoptysis, sudden weight loss or worsening breathlessness between checks requires same-week clinical review.
-
Severe airflow obstruction
Spirometry in the severe range (FEV1 < 50% predicted) needs prompt respiratory review and pulmonary rehabilitation referral.
-
Post-COVID lung disease
Persistent post-COVID changes on LDCT — organising pneumonia or fibrosis — need respiratory-clinic follow-up.
-
Occupational lung disease
Asbestos exposure, silicosis and other occupational patterns require dedicated occupational-respiratory input.
-
Alpha-1 antitrypsin deficiency
Early-onset lower-zone emphysema in a smoker under 45 should prompt alpha-1 antitrypsin testing.
-
Interstitial pneumonia with hypoxia
ILD features on LDCT with resting hypoxia warrant urgent ILD-MDT referral.
-
Family lung cancer under 50
A first-degree relative with lung cancer under 50 raises baseline risk and may justify earlier or more frequent screening.
Reading your report
A lung health check report can look intimidating. It isn’t.
Whatever the finding, the report keeps to the same four parts.
A quiet reminder
The report is written for your doctor, not for you — and that’s normal.
If you would like us to talk you through it before your follow-up, just ask.
- 01 Header
Indication and risk factors
Your details, smoking pack-years, occupational exposures and family history — the context that shapes interpretation.
- 02 Technique
LDCT protocol and dose
Confirmation of the low-dose protocol, dose-length product, and that no intravenous contrast was used.
- 03 Findings
Nodules, parenchyma and incidentals
Nodule size and morphology, emphysema quantification, mediastinal review and any extra-pulmonary incidental findings.
- 04 Impression
Lung-RADS category and next step
The single Lung-RADS category with the concrete next step — no action, surveillance interval or 2WW referral.
Frequently asked
Everything patients ask about the lung health check.
Quick answers on eligibility, radiation, spirometry, nodules and when to worry.
-
What is an NHS lung health check?
It is a structured NHS assessment offered to people aged 55–74 with a smoking history. It combines a symptom review, a spirometry breathing test and a low-dose CT (LDCT) scan of the chest, plus personalised advice on smoking cessation, inhaler therapy and cardiovascular risk. The programme has been shown to reduce lung cancer mortality by around 20%.
-
Who is eligible for a lung health check?
The NHS Targeted Lung Health Check invites adults aged 55–74 who currently smoke or have smoked in the past. Eligibility is confirmed at a short telephone or clinic review. People outside the age range with a strong personal or family history of lung disease can arrange a private lung health check.
-
How much radiation does a low-dose CT scan use?
Around 1.5 millisieverts — significantly less than a standard chest CT and comparable to about six months of natural background radiation in the UK. The benefit of early cancer detection in eligible smokers substantially outweighs the small radiation risk.
-
What happens if a nodule is found?
Most pulmonary nodules are benign. Small, benign-appearing nodules are followed with interval CT scans according to Fleischner Society guidance. Larger or higher-risk nodules are classified using Lung-RADS and, if suspicious, discussed at the lung-cancer MDT with a rapid biopsy or PET-CT plan.
-
Do I need to stop smoking before my scan?
No — the check is designed for current smokers as well as ex-smokers. What you will be offered is evidence-based cessation support at the same visit, because stopping smoking after a lung health check is one of the most effective single actions you can take for your health.
-
When is a lung symptom a medical emergency?
Coughing up more than a small amount of blood, sudden severe breathlessness or chest pain, or rapid unexplained weight loss with a new cough are all reasons to seek urgent medical assessment — 999 or A&E for acute breathlessness or significant haemoptysis, not a private appointment.
Sources
Where this guide comes from.
- NHS. Targeted Lung Health Check programme.
- NICE. Lung cancer: diagnosis and management (NG122).
- British Thoracic Society. Guidelines on COPD and pulmonary rehabilitation.
- Public Health England. Lung cancer screening evidence review.
Reviewed by Pulse Atlas Editorial Board (). Last reviewed 2026-07-30. Next review 2027-07-30.
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In practice, in London
How lung health check tends to unfold when you go private
With lung health check, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. Public provision for lung health check is competent but constrained by capacity. Private London clinics tend to have shorter diaries and longer appointment slots, so you get the same specialists with more time. For people who’ve been going round in circles with primary care, that first proper conversation is often what shifts things.
The mechanics are straightforward: a consultant appointment, any tests done at a nearby CQC-registered site, and a written report back within a few days. London’s density of private diagnostics — Marylebone, the City, Chelsea, Canary Wharf — means most patients can find something that fits around work without a cross-town trek. For lung health check specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
Where a good concierge earns its keep is in the matching. There are dozens of consultants in London who see lung health check — but not all of them are the right fit for every case. We narrow it down based on subspecialty, insurer coverage, the specific question being asked, and whether continuity into treatment matters. The right first appointment saves you from repeating yourself later.