A prospective analysis was undertaken to evaluate the efficacy of performing routine whole lung tomography in addition to conventional chest radiography in the initial staging and subsequent management of 120 patients with seminomatous and nonseminomatous germ cell tumors. Two hundred fifty whole lung tomographs were performed on these patients. At presentation, only one patient (0.8%) had positive tomography with simultaneously normal posteroanterior and lateral chest films. On follow-up tomographic examinations, three patients had metastases when chest roentgenographs were normal. In only one patient was therapy altered by tomographic findings. The results indicate that routine whole lung tomography is not useful or cost-effective in the initial staging and subsequent management of patients with germ cell tumors.