New sputum negative (NSN) tuberculosis case detection in Jalpaiguri district has been consistently low. Availability and accessibility of health facilities with chet x-rays is key for the diagnosis of NSN cases. To identify factors associated with utilisation of x-ray facilities in the district, we interviewed 4,875 chest symptomatics who were sputum negative on two occasions with an antibiotics course in between. Chest radiography was available in only three public health facilities in the district. Low income, long distance from the public health facilities with chest radiography and high cost of x-rays at private hospitals were key factors associated with symptomatics not undergoing X-ray. It is necessary to increase facilities for radiological diagnosis and provide mobility support for the symptomatics in Jalpaiguri.