Mulshine, James LJames LMulshineAvila, Ricardo SRicardo SAvilaSilva, MarioMarioSilvaAldige, CarolynCarolynAldigeBlum, TorstenTorstenBlumCham, MatthewMatthewChamde Koning, Harry JHarry Jde KoningFain, Sean BSean BFainField, JohnJohnFieldFlores, RajaRajaFloresGiger, Maryellen LMaryellen LGigerGipp, IlyaIlyaGippGrannis, Frederic WFrederic WGrannisGratama, Jan Willem CJan Willem CGratamaHealton, CherylCherylHealtonKazerooni, Ella AElla AKazerooniKelly, KarenKarenKellyLancaster, Harriet LHarriet LLancasterMontuenga, Luis MLuis MMontuengaMyers, Kyle JKyle JMyersNaghavi, MortezaMortezaNaghaviOsarogiagbon, RaymondRaymondOsarogiagbonPastorino, UgoUgoPastorinoPyenson, Bruce SBruce SPyensonReeves, Anthony PAnthony PReevesRizzo, AlbertAlbertRizzoRoss, SheilaSheilaRossSchneider, VictoriaVictoriaSchneiderSeijo, Luis MLuis MSeijoShaham, DorithDorithShahamSmith, RobertRobertSmithTaoli, EmanuelaEmanuelaTaoliTen Haaf, KevinKevinTen Haafvan der Aalst, Carlijn MCarlijn Mvan der AalstViola, LuciaLuciaViolaVogel-Claussen, JensJensVogel-ClaussenWalstra, Anna N HAnna N HWalstraWu, NingNingWuPAN-CHYR YANGYip, RowenaRowenaYipOudkerk, MatthijsMatthijsOudkerkHenschke, Claudia IClaudia IHenschkeYankelelvitz, David FDavid FYankelelvitz2025-05-142025-05-142025-05-02https://scholars.lib.ntu.edu.tw/handle/123456789/729283Lung cancer screening implementation has led to expanded imaging of the chest in older, tobacco-exposed populations. Growing numbers of screening cases are also found to have CT-detectable emphysema or elevated levels of coronary calcium, indicating the presence of coronary artery disease. Early interventions based on these additional findings, especially with coronary calcium, are emerging and follow established protocols. Given the pace of diagnostic innovation and the potential public health impact, it is timely to review issues in developing useful chest CT screening infrastructure as chest CT screening will soon involve millions of participants worldwide. Lung cancer screening succeeds because it detects curable, early primary lung cancer by characterizing and measuring changes in non-calcified, lung nodules in the size-range from 3mm to 15 mm in diameter. Therefore, close attention to imaging methodology is essential to lung screening success and similar image quality issues are required for reliable quantitative characterization of early emphysema and coronary artery disease. Today's emergence of advanced image analysis using artificial intelligence (AI) is disrupting many aspects of medical imaging including chest CT screening. Given these emerging technological and volume trends, a major concern is how to balance the diverse needs of parties committed to building AI tools for precise, reproducible, and economical chest CT screening, while addressing the public health needs of screening participants receiving this service. A new consortium, the Alliance for Global Implementation of Lung and Cardiac Early Disease Detection and Treatment (AGILE) is committed to facilitate broad, equitable implementation of multi-disciplinary, high quality chest CT screening using advanced computational tools at accessible cost.enArtificial intelligenceChest CT scanChronic obstructive pulmonary diseaseCoronary artery diseaseEmphysemaLung cancerLung cancer screeningreview article10.1016/j.ejca.2025.11534540090215