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Implementation of lung cancer screening is a challenge for radiology. The present short review summarizes major requirements which are needed to ensure high rates of diagnostic accuracy and appropriate protocols for follow-up and invasive work-up. Standardization of procedures, structured reporting, assessment of quality metrics, close multidisciplinary collaboration, and continuous education are essential. Additional quantification of coronary artery calcium and emphysema may provide synergistic medical benefits for a lung cancer screening programme.