Artificial Intelligence in Low-Dose Computed Tomography Screening of the Chest: Past, Present, and Future

The integration of artificial intelligence (AI) with low-dose computed tomography (LDCT) has the potential to transform lung cancer screening into a comprehensive approach to early detection of multiple diseases. Building on over 3 decades of research and global implementation by the International Early Lung Cancer Action Program (I-ELCAP), this paper reviews the development and clinical integration of AI for interpreting LDCT scans. We describe the historical milestones in AI-assisted lung nodule detection, emphysema quantification, and cardiovascular risk assessment using visual and quantitative imaging features. We also discuss challenges related to image acquisition variability, ground truth curation, and clinical integration, with a particular focus on the design and implementation of the open-source IELCAP-AIRS system and the ScreeningPLUS infrastructure, which enable AI training, validation, and deployment in real-world screening environments. AI algorithms for rule-out decisions, nodule tracking, and disease quantification have the potential to reduce radiologist workload and advance precision screening. With the ability to evaluate multiple diseases from a single LDCT scan, AI-enabled screening offers a powerful, scalable tool for improving population health. Ongoing collaboration, standardized protocols, and large annotated datasets are critical to advancing the future of integrated, AI-driven preventive care.