In large clinical studies, lung cancer screening has been demonstrated to be effective in reducing lung cancer mortality in defined high risk populations using low-dose CT techniques. However, in different studies, results and definitions of persons of high risk have varied which needs to be taken into account when screening programmes should be implemented in clinical routine. In order those programmes to be as effective as possible, the careful definition of a risk population is crucial as much as the careful use of radiant exposure. Ideally, the number of false positive findings should be as low as possible with the best reduction in lung cancer mortality and limited financial burden.