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Since the publication of the National Lung Screening Trial (NLST) showing a mortality reduction with use of low dose computed tomography (LDCT) there has been considerable interest about the use of this modality to screen for lung cancer. This article reviews the NLST and current evidence behind screening for lung cancer in smokers.  It also attempts to look at different lung cancer risk models to help better define the ideal target population and lastly touches on the cost-effectiveness of LDCT screening in patients at high risk of lung cancer.