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Tuberculosis is on the increase in Italy as in other industrial countries. The key to tuberculosis control is case finding and radiology plays a major role in both active and passive tuberculosis diagnosis. Have recent advances in radiologic techniques increased the value of conventional radiology? Has the role of chest radiography changed in tuberculosis screening? To answer these questions we examined a population referred to our hospital for both screening and diagnostic purposes over a 12-month period. In a population of 31,730 inhabitants, 1,461 chest radiographs were performed, 226 (15.4%) for passive and the others for active case finding. As for active case finding, high-risk patients were screened (21 immigrants and 296 aging people), together with the general population believed to be at risk according to current national recommendations (918 chest films). While screening allowed the diagnosis of only one tuberculosis case in the high-risk group, 3 cases were found in the symptomatic group with the passive protocol. In our experience, new radiologic techniques have not made the diagnosis of tuberculosis easier. Unlike in cancers, CT was not particularly useful in identifying symptomatic tuberculosis cases. In our experience, screening yielded poor results: in fact, this attempt at preventing tuberculosis caused an unreasonable waste of time and money because when screening low-risk groups many films are needed to diagnose a single case. Thus, the reason for this failure was not a technical one. It proved to be a problem of selecting the population to be screened. Our results suggest that no major change has taken place in the role of conventional radiology in passive tuberculosis case finding and that radiology must be used differently in passive case finding, that is, for screening purposes in high-risk groups only.